Healthcare Provider Details

I. General information

NPI: 1023228608
Provider Name (Legal Business Name): JUANA LOPEZ C.E.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13371 SW 34 ST
MIAMI FL
33175
US

IV. Provider business mailing address

13371 SW 34TH ST
MIAMI FL
33175-6908
US

V. Phone/Fax

Practice location:
  • Phone: 305-225-6054
  • Fax:
Mailing address:
  • Phone: 305-225-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1103X
TaxonomyResearch Study Abstracter/Coder
License NumberK6573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: