Provider Demographics
NPI:1215443031
Name:LOPEZ, CRISTINA I
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:I
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 RIDGELAND DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7135
Mailing Address - Country:US
Mailing Address - Phone:305-733-4509
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3424
Practice Address - Country:US
Practice Address - Phone:561-335-5681
Practice Address - Fax:561-210-5502
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-18-30198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician