Healthcare Provider Details

I. General information

NPI: 1316853393
Provider Name (Legal Business Name): MARIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 PINES BLVD # 310
PEMBROKE PINES FL
33027-1212
US

IV. Provider business mailing address

16000 PINES BLVD UNIT 825022
PEMBROKE PINES FL
33082-9326
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-0918
  • Fax:
Mailing address:
  • Phone: 954-372-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: