Healthcare Provider Details

I. General information

NPI: 1336052844
Provider Name (Legal Business Name): HEATHER LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 114TH AVE STE 604
LARGO FL
33773-5124
US

IV. Provider business mailing address

3420 JARROD LN
LAKELAND FL
33810-0667
US

V. Phone/Fax

Practice location:
  • Phone: 727-492-5369
  • Fax:
Mailing address:
  • Phone: 656-238-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: