Provider Demographics
NPI:1144888033
Name:LOPEZ, LUCELIX PILAR (RPT)
Entity type:Individual
Prefix:MRS
First Name:LUCELIX
Middle Name:PILAR
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CALLE CIELO MAR
Mailing Address - Street 2:URB PARAISO DE GURABO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-3739
Mailing Address - Country:US
Mailing Address - Phone:787-961-3636
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE PADIAL STE 240
Practice Address - Street 2:PLAZA GATSBY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3841
Practice Address - Country:US
Practice Address - Phone:787-961-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038843300Medicaid