Individual
PROVIDENCIA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTAL
Contact information
Practice address
I42 CALLE SAGITARIO, PONCE, PR 00716-0910
(787) 901-9425
Mailing address
I42 CALLE SAGITARIO, PONCE, PR 00716-0910
(787) 901-9425
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
823
PR
Other
Enumeration date
11/27/2019
Last updated
11/27/2019
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