Provider Demographics
NPI:1740300060
Name:LOPEZ, LUZ DIVINA (PSICOLOGY)
Entity type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:DIVINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSICOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. E. APL 497
Mailing Address - Street 2:SUITE 728
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-617-2657
Mailing Address - Fax:787-281-6992
Practice Address - Street 1:SUITE 728 AVE. E.POL #497
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-617-2657
Practice Address - Fax:787-281-6992
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002663103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service