Provider Demographics
NPI:1215515903
Name:LOPEZ PEREZ, ANNELIS
Entity type:Individual
Prefix:
First Name:ANNELIS
Middle Name:
Last Name:LOPEZ PEREZ
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 1:5353 HAWKS LANDING DR APT 207
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6665
Mailing Address - Country:US
Mailing Address - Phone:239-288-3823
Mailing Address - Fax:
Practice Address - Street 1:11922 FAIRWAY LAKES DR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8384
Practice Address - Country:US
Practice Address - Phone:239-219-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician