Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14555 | PR |
NPI | 1043349590 |
---|---|
Provider Name | Dr. Brenda I. Lopez |
First Address | Ponce, PR 00717 |
Second Address | Juana Diaz, PR 00795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |