Provider Demographics
NPI:1194736348
Name:LOPERENA LOPEZ, DIANA (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LOPERENA LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CARR 2 STE 302
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6064
Mailing Address - Country:US
Mailing Address - Phone:787-859-4829
Mailing Address - Fax:787-859-4781
Practice Address - Street 1:ORTIZ MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-4829
Practice Address - Fax:787-859-4781
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1635122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist