1205163755 NPI number — MS. DORIS I ROMERO LOPEZ M.A.

Table of content: MS. DORIS I ROMERO LOPEZ M.A. (NPI 1205163755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205163755 NPI number — MS. DORIS I ROMERO LOPEZ M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO LOPEZ
Provider First Name:
DORIS
Provider Middle Name:
I
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205163755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1274
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-449-5428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 AVE. NATIVO ALERS DESVIO SUR
Provider Second Line Business Practice Location Address:
BO. PIEDRAS BLANCAS SUITE 112
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-449-0449
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  001582 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1582 . This is a "PSICOLOGIST" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 001582 . This is a "INTERNATIONAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".