Provider Demographics
NPI:1477300242
Name:LOPEZ ORTIZ, ESTEFANIA (DC)
Entity type:Individual
Prefix:DR
First Name:ESTEFANIA
Middle Name:
Last Name:LOPEZ ORTIZ
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:PO BOX 3534
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-3534
Mailing Address - Country:US
Mailing Address - Phone:787-392-8740
Mailing Address - Fax:
Practice Address - Street 1:110 AVE. 21 DE DICIEMBRE
Practice Address - Street 2:OFICINA #10
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-0000
Practice Address - Country:US
Practice Address - Phone:939-438-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor