Healthcare Provider Details

I. General information

NPI: 1255252037
Provider Name (Legal Business Name): MR. PRINCE X LOPES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SHAWMUT AVE
NEW BEDFORD MA
02740-4429
US

IV. Provider business mailing address

124 SHAWMUT AVE
NEW BEDFORD MA
02740-4429
US

V. Phone/Fax

Practice location:
  • Phone: 508-972-5043
  • Fax:
Mailing address:
  • Phone: 508-972-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberS94662255
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: