Provider Demographics
NPI:1962958942
Name:LOPEZ, REBECCA ALMA-ROSA (RN)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ALMA-ROSA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 107TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1226
Mailing Address - Country:US
Mailing Address - Phone:347-724-4976
Mailing Address - Fax:
Practice Address - Street 1:6135 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2771
Practice Address - Country:US
Practice Address - Phone:718-271-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse