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NPI Code Detail

MEDICARE: AVERY LOPEZ

MEDICARE: AVERY LOPEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1013439850
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY LOPEZ
Provider Business Mailing Address
First Line : 1329 ALIVIA DR
Second Line :
City : PLAINWELL
State : MI
Zip : 49080-1446
Country : US
Telephone Number : 269-352-3082
Fax Number :
Provider Business Practice Location Address
First Line : 4625 W KL AVE
Second Line :
City : KALAMAZOO
State : MI
Zip : 49006-6209
Country : US
Telephone Number : 269-352-3082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2017
Last Update Date : 04/04/2024

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Directions to “ AVERY LOPEZ ” Practice Location

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