Provider Demographics
NPI:1992315022
Name:LOPEZ DUENAS, LAURA CARIDAD
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CARIDAD
Last Name:LOPEZ DUENAS
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 1:8005 NW 8TH ST APT 126B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2802
Mailing Address - Country:US
Mailing Address - Phone:786-683-0310
Mailing Address - Fax:
Practice Address - Street 1:8005 NW 8TH ST APT 126B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2802
Practice Address - Country:US
Practice Address - Phone:786-683-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-121181106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician