Provider Demographics
NPI:1306272646
Name:LOPEZ RAMOS, IDALIS (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:IDALIS
Middle Name:
Last Name:LOPEZ RAMOS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 CALLE FINLANDIA
Mailing Address - Street 2:PLAZA DE LAS FUENTES
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-648-9596
Mailing Address - Fax:
Practice Address - Street 1:1162 CALLE FINLANDIA
Practice Address - Street 2:PLAZA DE LAS FUENTES
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-648-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist