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General NPI Number Information
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NPI Number | 1740961713
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Entity Type | Individual
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Provider Name | MARTINA BIANCA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 9915 NW 41ST ST STE 220
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City | DORAL
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State | FL
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Zip | 33178-2445
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Country | US
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Telephone | 305-558-3724
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Fax | 786-907-4485
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Provider Business Mailing Address
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Address Line | 15280 NW 79TH CT STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5873
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Country | US
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Telephone | 305-558-3724
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Fax | 786-907-4485
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 11401
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License Number State | FL
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