Healthcare Provider Details

I. General information

NPI: 1114553401
Provider Name (Legal Business Name): NAOMI LOPEZ FIGUEROA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 GOLDEN BEAK DR FL 33839
EAGLE LAKE FL
33839-5706
US

IV. Provider business mailing address

1907 GOLDEN BEAK DR FL 33839
EAGLE LAKE FL
33839-5706
US

V. Phone/Fax

Practice location:
  • Phone: 863-264-0639
  • Fax: 863-204-0935
Mailing address:
  • Phone: 863-264-0639
  • Fax: 863-204-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: