Provider Demographics
NPI:1992314843
Name:LOPEZ PENA, MILAGROS LAZARA (RBT)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:LAZARA
Last Name:LOPEZ PENA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 SW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1717
Mailing Address - Country:US
Mailing Address - Phone:786-205-9640
Mailing Address - Fax:
Practice Address - Street 1:14501 SW 162ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1717
Practice Address - Country:US
Practice Address - Phone:786-205-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123352106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician