Provider Demographics
NPI:1982564548
Name:LOPEZ SANTOS, YAQUELIN
Entity type:Individual
Prefix:MRS
First Name:YAQUELIN
Middle Name:
Last Name:LOPEZ SANTOS
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 1:8851 NW 119TH ST UNIT 4216
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7914
Mailing Address - Country:US
Mailing Address - Phone:786-578-6476
Mailing Address - Fax:
Practice Address - Street 1:8851 NW 119TH ST UNIT 4216
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-7914
Practice Address - Country:US
Practice Address - Phone:786-578-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-490010106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician