Provider Demographics
NPI:1699272104
Name:MOJICA GONZALEZ, LORELYS H (DC)
Entity type:Individual
Prefix:
First Name:LORELYS
Middle Name:H
Last Name:MOJICA GONZALEZ
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 12143
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-0143
Mailing Address - Country:US
Mailing Address - Phone:873-000-8537
Mailing Address - Fax:787-936-2523
Practice Address - Street 1:URB. SANTIAGO IGLESIAS
Practice Address - Street 2:CALLE MANUEL OCASIO #1445
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4132
Practice Address - Country:US
Practice Address - Phone:787-300-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor