Provider Demographics
NPI:1700585684
Name:LOPEZ, NYDIA LISVETTE (THL)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:LISVETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CAMINO DEL MONTE 36
Mailing Address - Street 2:COLINAS DE PLATA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-636-3104
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 8.2 BO. JUAN SANCHEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-7087
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3245S0500X
PR5392355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children