Provider Demographics
NPI:1346763695
Name:LOPEZ FUSTES, REBECA
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:LOPEZ FUSTES
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 1:6361 COW PEN RD APT T212
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2208
Mailing Address - Country:US
Mailing Address - Phone:305-321-2342
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:8884 W 35TH WAY
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1889
Practice Address - Country:US
Practice Address - Phone:305-967-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL0-19-10346106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst