Provider Demographics
NPI:1215491550
Name:LOPEZ MAYSONET, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:LOPEZ MAYSONET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERVIN
Other - Middle Name:
Other - Last Name:SANCHEZ-MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:URB. MONTE CARLO MA-35 PLAZA 7
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4723
Mailing Address - Country:US
Mailing Address - Phone:787-314-6825
Mailing Address - Fax:787-658-7116
Practice Address - Street 1:CALLE SANTA CRUZ B-11
Practice Address - Street 2:URB. SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0060
Practice Address - Country:US
Practice Address - Phone:787-993-1350
Practice Address - Fax:787-658-7116
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR70Medicaid