Provider Demographics
NPI:1801137450
Name:LOPEZ, DIANA IVETTE (PHARM TECH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:IVETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM TECH
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:IVETTE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6328
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9547
Mailing Address - Country:US
Mailing Address - Phone:787-222-9796
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6328
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9547
Practice Address - Country:US
Practice Address - Phone:787-222-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1678183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician