Provider Demographics
NPI:1467066837
Name:LOPEZ, MARIA INES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:INES
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 1:14525 SW 298TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3941
Mailing Address - Country:US
Mailing Address - Phone:786-259-2206
Mailing Address - Fax:
Practice Address - Street 1:2331 SW 82ND PL STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1252
Practice Address - Country:US
Practice Address - Phone:305-448-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician