Provider Demographics
NPI:1750840427
Name:LOPEZ JIMENEZ, SILMACORAL MARYVI (NATUROPATHIC DOCTOR)
Entity type:Individual
Prefix:
First Name:SILMACORAL
Middle Name:MARYVI
Last Name:LOPEZ JIMENEZ
Suffix:
Gender:F
Credentials:NATUROPATHIC DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KK10 CALLE 32
Mailing Address - Street 2:EXT VILLA RITA
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-248-9155
Mailing Address - Fax:
Practice Address - Street 1:204 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-234-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR47175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath