Healthcare Provider Details

I. General information

NPI: 1386295814
Provider Name (Legal Business Name): ANNIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 FOREST HILL BLVD STE 3
WEST PALM BEACH FL
33406-6031
US

IV. Provider business mailing address

3518 OLD LIGHTHOUSE CIR
WELLINGTON FL
33414-8841
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 786-953-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50939
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-97153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: