Provider Demographics
NPI:1407037336
Name:LOPEZ, GRACE M
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140313
Mailing Address - Street 2:ARECIBO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0313
Mailing Address - Country:US
Mailing Address - Phone:787-438-5140
Mailing Address - Fax:787-881-7733
Practice Address - Street 1:CALLE SANTA TERESA 7
Practice Address - Street 2:ARECIBO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-438-5140
Practice Address - Fax:787-881-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 4973416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport