Healthcare Provider Details

I. General information

NPI: 1598693624
Provider Name (Legal Business Name): MAYBELIS GARCIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 NW 162ND ST
OPA LOCKA FL
33054-6859
US

IV. Provider business mailing address

2921 NW 162ND ST
OPA LOCKA FL
33054-6859
US

V. Phone/Fax

Practice location:
  • Phone: 786-203-8959
  • Fax:
Mailing address:
  • Phone: 786-203-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: