MEDICARE: ADAIRIS PAEZ LOPEZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1265294060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAIRIS PAEZ LOPEZ

Provider Business Mailing Address
First Line	:	8040 NW 95TH ST STE 217
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2361
Country	:	US
Telephone Number	:	954-397-8635
Fax Number	:	786-536-6632

Provider Business Practice Location Address
First Line	:	2986 NW 31ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5844
Country	:	US
Telephone Number	:	786-482-3927
Fax Number	:

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

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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Directions to “ ADAIRIS PAEZ LOPEZ ” Practice Location

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