Provider Demographics
NPI:1962909283
Name:LOPEZ RIVERA, YAMILETTE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:YAMILETTE
Middle Name:MARIE
Last Name:LOPEZ RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 UNIVERSITY BLVD S STE B3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4223
Mailing Address - Country:US
Mailing Address - Phone:904-434-3465
Mailing Address - Fax:904-802-7977
Practice Address - Street 1:3636 UNIVERSITY BLVD S STE B3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4223
Practice Address - Country:US
Practice Address - Phone:904-434-3465
Practice Address - Fax:904-802-7977
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor