Provider Demographics
NPI:1487416616
Name:BECERRA LOPEZ, JONATHAN L (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:BECERRA LOPEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT JARD DE COAMO
Mailing Address - Street 2:CALLE 13 F2
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-648-1863
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE FLORENCIO SANTIAGO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3208
Practice Address - Country:US
Practice Address - Phone:787-648-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor