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General NPI Number Information
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NPI Number | 1780786293
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Entity Type | Individual
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Provider Name | ICEL LOPEZ-DELGADO
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Gender | Male
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 2300 W 84TH ST STE 105 2300 W 84 TH STREET SUITE 105
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City | HIALEAH
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State | FL
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Zip | 33016-5771
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Country | US
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Telephone | 786-666-0507
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Fax | 786-666-0419
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Provider Business Mailing Address
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Address Line | 11031 NE 6TH AVE 2300 W 84 TH STREET SUITE 105
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City | HIALEAH
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State | FL
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Zip | 33016-7182
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Country | US
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Telephone | 786-666-0507
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Fax | 786-666-0419
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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