Healthcare Provider Details

I. General information

NPI: 1689289654
Provider Name (Legal Business Name): BIANCA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7376 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

IV. Provider business mailing address

7376 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

V. Phone/Fax

Practice location:
  • Phone: 561-788-4086
  • Fax:
Mailing address:
  • Phone: 561-788-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12237
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: