Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1909 | PR |
Y | 103TC0700X | Clinical Psychologist | 1909 | PR |
NPI | 1003826637 |
---|---|
Provider Name | Lizaida Lopez |
First Address | Guaynabo, PR 00969-3938 |
Second Address | San Juan, PR 00926-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |