MEDICARE: YUKIE LOPEZ IZAGUIRRE TCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093308561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUKIE LOPEZ IZAGUIRRE TCM

Provider Business Mailing Address
First Line	:	18120 NW 59TH AVE APT 206
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5219
Country	:	US
Telephone Number	:	786-832-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	18120 NW 59TH AVE APT 206
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5219
Country	:	US
Telephone Number	:	786-832-5277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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