Provider Demographics
NPI:1285755884
Name:LOPEZ, ROSAURA (MSW)
Entity type:Individual
Prefix:
First Name:ROSAURA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 CALLE AMARILLO
Mailing Address - Street 2:COND. LOS CEDROS APT. 5402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3056
Mailing Address - Country:US
Mailing Address - Phone:787-773-0464
Mailing Address - Fax:787-294-1569
Practice Address - Street 1:1687 CALLE AMARILLO
Practice Address - Street 2:COND. LOS CEDROS APT. 5402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3056
Practice Address - Country:US
Practice Address - Phone:787-773-0464
Practice Address - Fax:787-294-1569
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83974HMedicare UPIN