MEDICARE: DELANEE 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
1	106E00000X	Assistant Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95406877D	OTHER	CA	CALVIVA HEALTH

General Provider Information

NPI Number	:	1013614577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELANEE LOPEZ

Provider Business Mailing Address
First Line	:	106 E ANDREWS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-4531
Country	:	US
Telephone Number	:	559-381-2624
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 ASHLEY PARK CT STE 503
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6196
Country	:	US
Telephone Number	:	321-972-4265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	02/14/2023

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Directions to “ DELANEE LOPEZ ” Practice Location

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