Provider Demographics
NPI:1417799917
Name:LOPEZ, ADRIAN OMAR
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:OMAR
Last Name:LOPEZ
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 1:18780 SW 294TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-2302
Mailing Address - Country:US
Mailing Address - Phone:786-366-9614
Mailing Address - Fax:
Practice Address - Street 1:18780 SW 294TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-2302
Practice Address - Country:US
Practice Address - Phone:786-366-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker