Provider Demographics
NPI:1962108100
Name:LOPEZ, EDUARDO JAVIER
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JAVIER
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 1:1791 EMILIO LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6514
Mailing Address - Country:US
Mailing Address - Phone:561-335-7243
Mailing Address - Fax:
Practice Address - Street 1:515 N FLAGLER DR STE P300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4326
Practice Address - Country:US
Practice Address - Phone:786-445-3334
Practice Address - Fax:561-448-6063
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-251427106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician