MEDICARE: AMANDA MARIA LOPEZ LOPEZ RBT-24-329077

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-24-329077	FL

General Provider Information

NPI Number	:	1972369429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIA LOPEZ LOPEZ RBT-24-329077

Provider Business Mailing Address
First Line	:	7850 W 28TH AVE APT 111
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7210
Country	:	US
Telephone Number	:	786-510-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 W 28TH AVE APT 111
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-7210
Country	:	US
Telephone Number	:	786-510-3133
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	01/20/2025

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