Provider Demographics
NPI:1104653567
Name:LOPEZ GONZALEZ, FRANKLIN YOBANI
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:YOBANI
Last Name:LOPEZ GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1111
Mailing Address - Country:US
Mailing Address - Phone:240-408-0813
Mailing Address - Fax:
Practice Address - Street 1:3804 ALLISON ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1111
Practice Address - Country:US
Practice Address - Phone:240-408-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004204374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide