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NPI Code Detail

MEDICARE: JACQUELINE LOPEZ

MEDICARE: JACQUELINE 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1588963276
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE LOPEZ
Provider Business Mailing Address
First Line : 11428 N 53RD ST
Second Line :
City : TAMPA
State : FL
Zip : 33617-2216
Country : US
Telephone Number : 813-374-9416
Fax Number :
Provider Business Practice Location Address
First Line : 11428 N 53RD ST
Second Line :
City : TAMPA
State : FL
Zip : 33617-2216
Country : US
Telephone Number : 813-374-9416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2011
Last Update Date : 03/21/2011

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Directions to “ JACQUELINE LOPEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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