Provider Demographics
NPI:1992477368
Name:REINOSO LOPEZ, ROSMEIBY
Entity type:Individual
Prefix:
First Name:ROSMEIBY
Middle Name:
Last Name:REINOSO LOPEZ
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 1:11590 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7695
Mailing Address - Country:US
Mailing Address - Phone:704-431-3458
Mailing Address - Fax:
Practice Address - Street 1:11590 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7695
Practice Address - Country:US
Practice Address - Phone:704-431-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-120039106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106479100Medicaid