Provider Demographics
NPI:1124828405
Name:LOPEZ ESPINOSA, OLDEYANES OLEDAY
Entity type:Individual
Prefix:
First Name:OLDEYANES
Middle Name:OLEDAY
Last Name:LOPEZ ESPINOSA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SE 31ST CT UNIT 205
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2377
Mailing Address - Country:US
Mailing Address - Phone:772-259-4218
Mailing Address - Fax:
Practice Address - Street 1:1320 SE 31ST CT UNIT 205
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2377
Practice Address - Country:US
Practice Address - Phone:772-259-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-397448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst