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General NPI Number Information
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NPI Number | 1407574007
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Entity Type | Individual
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Provider Name | MS. DESTINI NICOLE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 133 WINDY MEADOWS DR
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City | SCHERTZ
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State | TX
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Zip | 78154-1539
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Country | US
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Telephone | 210-447-0039
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Fax |
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Provider Business Mailing Address
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Address Line | 14614 VANCE JACKSON RD APT 2310
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City | SAN ANTONIO
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State | TX
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Zip | 78249-3242
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Country | US
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Telephone | 817-851-5909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 35970642
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License Number State | TX
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