Healthcare Provider Details

I. General information

NPI: 1558858241
Provider Name (Legal Business Name): KATIA LOPEZ MANZANEDO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 W 35TH AVE UNIT 157
HIALEAH FL
33018-7122
US

IV. Provider business mailing address

7001 W 35TH AVE UNIT 157
HIALEAH FL
33018-7122
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-0005
  • Fax: 786-657-0005
Mailing address:
  • Phone: 786-657-0005
  • Fax: 786-657-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82126
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: