Provider Demographics
NPI:1396000980
Name:LOPEZ AQUINO, YANIRA (YANIRA LOPEZ AQUINO)
Entity type:Individual
Prefix:DR
First Name:YANIRA
Middle Name:
Last Name:LOPEZ AQUINO
Suffix:
Gender:F
Credentials:YANIRA LOPEZ AQUINO
Other - Prefix:DR
Other - First Name:YANIRA
Other - Middle Name:
Other - Last Name:LOPEZ AQUINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:SEVILLA ST. #71 VISTA ALEGRE
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-955-1598
Mailing Address - Fax:
Practice Address - Street 1:BO MONACILLOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-754-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist