Provider Demographics
NPI:1285433920
Name:POMPA LOPEZ, DAILENIS
Entity type:Individual
Prefix:
First Name:DAILENIS
Middle Name:
Last Name:POMPA LOPEZ
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 1:754 PONDELLA RD APT 131
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-6704
Mailing Address - Country:US
Mailing Address - Phone:239-445-8890
Mailing Address - Fax:239-445-8890
Practice Address - Street 1:754 PONDELLA RD APT 131
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-6704
Practice Address - Country:US
Practice Address - Phone:239-445-8890
Practice Address - Fax:239-445-8890
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician