MEDICARE: ANA I GUTIERREZ 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	106S00000X	Behavior Technician	RBT-22-210466	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205579174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA I GUTIERREZ LOPEZ

Provider Business Mailing Address
First Line	:	2707 FREEPORT RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-7710
Country	:	US
Telephone Number	:	561-475-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4793 N CONGRESS AVE STE 203
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7937
Country	:	US
Telephone Number	:	561-429-3863
Fax Number	:	561-448-6063

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

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/20/2026

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Directions to “ ANA I GUTIERREZ LOPEZ ” Practice Location

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