Provider Demographics
NPI:1740882885
Name:LOPEZ FERNANDEZ, MINAYRA M (MSW)
Entity type:Individual
Prefix:MRS
First Name:MINAYRA
Middle Name:M
Last Name:LOPEZ FERNANDEZ
Suffix:
Gender:F
Credentials:MSW
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 51502
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1502
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-936-7374
Practice Address - Street 1:AVE COMERIO #600
Practice Address - Street 2:A LA ORDEN SHOPPING PLAZA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950-1502
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-936-7374
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty