Healthcare Provider Details

I. General information

NPI: 1740070549
Provider Name (Legal Business Name): HEILI KEMEL LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 GLADES RD STE 324A
BOCA RATON FL
33431-8571
US

IV. Provider business mailing address

9983 SW 155TH ST
MIAMI FL
33157-1638
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-0296
  • Fax:
Mailing address:
  • Phone: 786-483-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: