Provider Demographics
NPI:1720276173
Name:DIAZ-LOPEZ, GLORIA LUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:LUZ
Last Name:DIAZ-LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330190
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0190
Mailing Address - Country:US
Mailing Address - Phone:783-259-0889
Mailing Address - Fax:787-259-0889
Practice Address - Street 1:PASEO CAMPINA
Practice Address - Street 2:VILLAS DE MONTE VERDE #3
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:783-259-0889
Practice Address - Fax:787-259-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist