Healthcare Provider Details

I. General information

NPI: 1275776064
Provider Name (Legal Business Name): INGRID VIRGINIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W FLAGLER ST STE 200
MIAMI FL
33144-2467
US

IV. Provider business mailing address

500 BAYVIEW DR APT 1821
SUNNY ISLES BEACH FL
33160-4779
US

V. Phone/Fax

Practice location:
  • Phone: 305-377-3297
  • Fax:
Mailing address:
  • Phone: 786-709-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-06679
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: