Healthcare Provider Details

I. General information

NPI: 1013614577
Provider Name (Legal Business Name): DELANEE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7635 ASHLEY PARK CT STE 503
ORLANDO FL
32835-6196
US

IV. Provider business mailing address

106 E ANDREWS AVE
FRESNO CA
93704-4531
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4265
  • Fax:
Mailing address:
  • Phone: 559-381-2624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: