Provider Demographics
NPI:1053526426
Name:DIANA LOPEZ
Entity type:Organization
Organization Name:DIANA LOPEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-530-2364
Mailing Address - Street 1:AVE CORAZON 1020
Mailing Address - Street 2:PMB 7999 BUZON 181
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-530-2364
Mailing Address - Fax:
Practice Address - Street 1:REPARTO FELICIANO # 3
Practice Address - Street 2:APARTAMENTO 1 A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-530-2364
Practice Address - Fax:787-259-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRP11223416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTC AMB 446OtherCOMISION SERVICIO PUBLICO