Individual
BLADYS JOHANNA LOPEZ VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICINE DOCTOR
Contact information
Practice address
CARR 464 KM 2.4, BO ACEITUNAS, MOCA, PR 00676
(787) 242-4366
Mailing address
HC 3 BOX 9110, MOCA, PR 00676-9265
(787) 242-4366
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
23512
PR
261QS1000X
Student Health Clinic/Center
—
PR
390200000X
Student in an Organized Health Care Education/Training Program
—
PR
Other
Enumeration date
08/02/2023
Last updated
03/03/2024
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