Provider Demographics
NPI:1124434196
Name:LOPEZ, TANIA (MS ED)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MS
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS ED
Mailing Address - Street 1:429-437 EAST 148 STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455
Mailing Address - Country:US
Mailing Address - Phone:718-585-0600
Mailing Address - Fax:718-585-0152
Practice Address - Street 1:31 NORTH ST
Practice Address - Street 2:#A4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7901
Practice Address - Country:US
Practice Address - Phone:718-329-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY833110141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist