Healthcare Provider Details

I. General information

NPI: 1518820406
Provider Name (Legal Business Name): DANIEL LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9545 KENWOOD RD STE 304
BLUE ASH OH
45242-6100
US

IV. Provider business mailing address

6826 OHIO AVE
CINCINNATI OH
45236-3844
US

V. Phone/Fax

Practice location:
  • Phone: 513-348-1780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2507641
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: