Provider Demographics
NPI:1285149237
Name:LOPEZ REYES, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:LOPEZ REYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6973 W 29TH AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-8317
Mailing Address - Country:US
Mailing Address - Phone:786-975-6481
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3237
Practice Address - Country:US
Practice Address - Phone:954-734-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician