Healthcare Provider Details

I. General information

NPI: 1861314569
Provider Name (Legal Business Name): PATRICIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S CONGRESS AVE
WEST PALM BEACH FL
33409-3823
US

IV. Provider business mailing address

1124 FOSTERS MILL DR
BOYNTON BEACH FL
33436-8700
US

V. Phone/Fax

Practice location:
  • Phone: 561-471-1688
  • Fax:
Mailing address:
  • Phone: 561-436-3209
  • 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: