Provider Demographics
NPI:1831885946
Name:LOPEZ RIVERA, RONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:LOPEZ RIVERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAND BLVD LOS PRADOS APT 1102
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3402
Mailing Address - Country:US
Mailing Address - Phone:787-205-1989
Mailing Address - Fax:
Practice Address - Street 1:500 GRAND BLVD LOS PRADOS APT 1102
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3402
Practice Address - Country:US
Practice Address - Phone:787-205-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical