Provider Demographics
NPI:1215620042
Name:MORALES LOPEZ, LYDIA DIANE (LMT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:DIANE
Last Name:MORALES LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 7908
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9736
Mailing Address - Country:US
Mailing Address - Phone:469-279-1994
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 629
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0629
Practice Address - Country:US
Practice Address - Phone:469-279-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist