Healthcare Provider Details

I. General information

NPI: 1396097820
Provider Name (Legal Business Name): CHRISTINA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14228 TURNING LEAF DR
ORLANDO FL
32828-7491
US

IV. Provider business mailing address

14228 TURNING LEAF DR
ORLANDO FL
32828-7491
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-3489
  • Fax:
Mailing address:
  • Phone: 321-961-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: