Individual
CHRISTINA NEREIDA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDM
Contact information
Practice address
107 RHODE ISLAND AVE, BAY SHORE, NY 11706-3210
(631) 219-5863
Mailing address
107 RHODE ISLAND AVE, BAY SHORE, NY 11706-3210
(631) 219-5863
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1039786161
NY
174400000X
Specialist
1039791161
NY
Other
Enumeration date
08/18/2016
Last updated
08/18/2016
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