Provider Demographics
NPI:1104818509
Name:LOPEZ, ELBA (RPT)
Entity type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CALLE DR HERNANDEZ DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3919
Mailing Address - Country:US
Mailing Address - Phone:787-872-0415
Mailing Address - Fax:787-872-0415
Practice Address - Street 1:7353 AVE RAMOS CALERO
Practice Address - Street 2:A
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3500
Practice Address - Country:US
Practice Address - Phone:787-872-0415
Practice Address - Fax:787-872-0415
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087123Medicare ID - Type Unspecified