Provider Demographics
NPI:1396425922
Name:LOPEZ, CHERYL DARLENE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DARLENE
Last Name:LOPEZ
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 1:3540 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5019
Mailing Address - Country:US
Mailing Address - Phone:843-443-5504
Mailing Address - Fax:
Practice Address - Street 1:2834 HOWARD AVE UNIT C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1902
Practice Address - Country:US
Practice Address - Phone:843-443-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist