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General NPI Number Information
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NPI Number | 1740826460
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Entity Type | Individual
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Provider Name | KATIUSKA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 4117 CORTEZ BLVD
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City | SEBRING
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State | FL
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Zip | 33872-1930
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Country | US
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Telephone | 305-987-2700
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Fax | 863-658-2043
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Provider Business Mailing Address
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Address Line | 5522 GRANADA BLVD
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City | SEBRING
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State | FL
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Zip | 33872-2327
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Country | US
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Telephone | 305-987-2700
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Fax | 863-451-5318
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | FL
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