Provider Demographics
NPI:1528237617
Name:LOPEZACEVEDO, CARMEN I (RPT)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:I
Last Name:LOPEZACEVEDO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1330
Mailing Address - Country:US
Mailing Address - Phone:787-879-0023
Mailing Address - Fax:
Practice Address - Street 1:AVE HOSTOS
Practice Address - Street 2:SUITE 1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-832-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist