Provider Demographics
NPI:1386127108
Name:LOPEZ CRESPO, CAMILLE ANAIS (DC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ANAIS
Last Name:LOPEZ CRESPO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CALLE 48
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9158
Mailing Address - Country:US
Mailing Address - Phone:939-247-3968
Mailing Address - Fax:
Practice Address - Street 1:1011 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2804
Practice Address - Country:US
Practice Address - Phone:787-751-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor