Provider Demographics
NPI:1144872821
Name:LOPEZ OYOLA, JONATHAN JOSE (LND)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JOSE
Last Name:LOPEZ OYOLA
Suffix:
Gender:M
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H35 CALLE TURABO
Mailing Address - Street 2:PARQUE LAS HACIENDAS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-219-7419
Mailing Address - Fax:
Practice Address - Street 1:CARR 173 KM 6.5
Practice Address - Street 2:SECTOR SAN JOSE BARRIO RABANAL
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2047133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education