Healthcare Provider Details

I. General information

NPI: 1356084792
Provider Name (Legal Business Name): CLAUDIA EMILY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E OAKLAND PARK BLVD STE 341
OAKLAND PARK FL
33334-2148
US

IV. Provider business mailing address

300 E OAKLAND PARK BLVD STE 341
OAKLAND PARK FL
33334-2148
US

V. Phone/Fax

Practice location:
  • Phone: 954-861-9161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21150462
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12473515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: