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General NPI Number Information
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NPI Number | 1790048973
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Entity Type | Individual
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Provider Name | GISELL ESTRELLA LOPEZ PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 1111 SW 85TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3353
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Country | US
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Telephone | 786-471-6980
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 SW 85TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3353
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Country | US
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Telephone | 786-471-6980
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8529
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License Number State | FL
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