Healthcare Provider Details

I. General information

NPI: 1760211247
Provider Name (Legal Business Name): LAURA G LOPEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13814 RUSHING CREEK RUN
ORLANDO FL
32824-9225
US

IV. Provider business mailing address

13814 RUSHING CREEK RUN
ORLANDO FL
32824-9225
US

V. Phone/Fax

Practice location:
  • Phone: 917-818-5058
  • Fax: 407-960-3009
Mailing address:
  • Phone: 917-818-5058
  • Fax: 407-960-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-363776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: