MEDICARE: DARIEL MORALES 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	RBT-19-85372	FL

General Provider Information

NPI Number	:	1699209346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIEL MORALES LOPEZ

Provider Business Mailing Address
First Line	:	1082 PLAZA DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-4069
Country	:	US
Telephone Number	:	407-334-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	1082 PLAZA DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-4069
Country	:	US
Telephone Number	:	407-334-5274
Fax Number	:

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

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	08/14/2024

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