Provider Demographics
NPI:1992398630
Name:LOPEZ PEREZ, MARIA AUXILIADORA (SA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:AUXILIADORA
Last Name:LOPEZ PEREZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 CARRICKTON CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4217
Mailing Address - Country:US
Mailing Address - Phone:407-316-6465
Mailing Address - Fax:
Practice Address - Street 1:2531 CARRICKTON CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4217
Practice Address - Country:US
Practice Address - Phone:407-316-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-133246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant