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General NPI Number Information
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NPI Number | 1619386307
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Entity Type | Individual
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Provider Name | JENNIFER SARAH LOPEZ OMD, DAOM
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Gender | Female
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 3661 S MIAMI AVE STE 705
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City | MIAMI
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State | FL
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Zip | 33133-4223
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Country | US
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Telephone | 305-650-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 15387 SW 150TH ST
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City | MIAMI
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State | FL
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Zip | 33196-2857
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Country | US
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Telephone | 305-484-5887
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3504
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License Number State | FL
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