1558958934 NPI number — NILSA IVELISSE LOPEZ LOPEZ BSW

Table of content: NILSA IVELISSE LOPEZ LOPEZ BSW (NPI 1558958934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558958934 NPI number — NILSA IVELISSE LOPEZ LOPEZ BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ LOPEZ
Provider First Name:
NILSA
Provider Middle Name:
IVELISSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSW
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:
1558958934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE BALDORIOTY NORTE 165, BUZON #2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIBONITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-545-0522
Provider Business Mailing Address Fax Number:
939-545-0700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CALLE ROSANTA AULET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAYUYA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-493-9340
Provider Business Practice Location Address Fax Number:
787-483-6056
Provider Enumeration Date:
12/31/2020

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: 104100000X , with the licence number:  25434 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X , with the licence number: 25434 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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