Provider Demographics
NPI:1902568983
Name:LOPEZ, GLORIA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 CALLE CALVEL
Mailing Address - Street 2:HACIENDA CONCORDIA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-901-0381
Mailing Address - Fax:
Practice Address - Street 1:CARR. 153 KM 12.4 LOCAL 3
Practice Address - Street 2:BO LAS FLORES
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-901-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1363224ZL0004X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision