1003139015 NPI number — JUANITA LOPEZ ORTIZ RPT

Table of content: JUANITA LOPEZ ORTIZ RPT (NPI 1003139015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003139015 NPI number — JUANITA LOPEZ ORTIZ RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ ORTIZ
Provider First Name:
JUANITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1003139015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 621
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUAS BUENAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00703-0621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 173 KM. 8.7
Provider Second Line Business Practice Location Address:
BARRIO SUMIDERO
Provider Business Practice Location Address City Name:
AGUAS BUENAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-732-0071
Provider Business Practice Location Address Fax Number:
787-732-0071
Provider Enumeration Date:
03/04/2010

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: 225100000X , with the licence number:  000935 , 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)





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