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General NPI Number Information
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NPI Number | 1992672307
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Entity Type | Organization
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Legal Business Name | THE MIRIAM LOPEZ FOUNDATION LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1979 S DELAWARE ST
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City | ALLENTOWN
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State | PA
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Zip | 18103-8523
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Country | US
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Telephone | 267-875-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 S DELAWARE ST
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City | ALLENTOWN
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State | PA
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Zip | 18103-8523
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Country | US
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Telephone | 267-875-3911
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | MR. MARTIN JESUS LOPEZ
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Credential | C.R.S
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Telephone | 610-663-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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