Provider Demographics
NPI:1326373200
Name:LOPEZ-CAMPOS, IRENE ANASTASIA (LMT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:ANASTASIA
Last Name:LOPEZ-CAMPOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 PONCE DE LEON
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-444-0442
Mailing Address - Fax:
Practice Address - Street 1:3310 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7284
Practice Address - Country:US
Practice Address - Phone:305-444-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist