Provider Demographics
NPI:1215733159
Name:LOPEZ ALFONSO, THAY LING
Entity type:Individual
Prefix:
First Name:THAY LING
Middle Name:
Last Name:LOPEZ ALFONSO
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 1:11027 SAILBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4035
Mailing Address - Country:US
Mailing Address - Phone:786-400-0590
Mailing Address - Fax:
Practice Address - Street 1:11027 SAILBROOKE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4035
Practice Address - Country:US
Practice Address - Phone:786-400-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician