Provider Demographics
NPI:1871311514
Name:LOPEZ SANTIAGO, KARYNA MICHELLE (TMS)
Entity type:Individual
Prefix:
First Name:KARYNA
Middle Name:MICHELLE
Last Name:LOPEZ SANTIAGO
Suffix:
Gender:F
Credentials:TMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB JARDINES DE SANTO DOMINGO CALLE 2 G2
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-298-7101
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE RAMON E BETANCES
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2632
Practice Address - Country:US
Practice Address - Phone:787-845-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical