MEDICARE: GIMENA ERMELINDA 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		FL

General Provider Information

NPI Number	:	1215874045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIMENA ERMELINDA LOPEZ

Provider Business Mailing Address
First Line	:	3651 SW 58TH AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-2734
Country	:	US
Telephone Number	:	786-859-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	11390 SW 21ST ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6633
Country	:	US
Telephone Number	:	305-515-5775
Fax Number	:

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

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

Similar Medicare Providers

1013530096 — KIDS BEHAVIORAL NETWORK, LLC
Practice Location Address:

11390 SW 21ST ST
MIRAMAR, FL
33025-6633

Practice Phone: 786-333-9275
Practice Fax:

1417650953 — ANISIA MARIA ARDERI CANELO OTR/L
Practice Location Address:

11370 SW 21ST ST
MIRAMAR, FL
33025-6633

Practice Phone: 786-879-2726
Practice Fax:

1780378919 — ROLANDO ACOSTA
Practice Location Address:

11340 SW 21ST ST
MIRAMAR, FL
33025-6633

Practice Phone: 954-309-8829
Practice Fax:

1679325070 — THE PEDS PLACE THERAPY, LLC
Practice Location Address:

11370 SW 21ST ST
MIRAMAR, FL
33025-6633

Practice Phone: 786-879-2726
Practice Fax:

1346113719 — ERNESTO ANTONIO SANCHEZ LA ROSA
Practice Location Address:

6633 COCONUT DR
MIRAMAR, FL
33023-4907

Practice Phone: 786-754-7589
Practice Fax:

1023214970 — MARTINE JULES MILLER LPN
Practice Location Address:

2101 SW 101ST AVE STE 206
MIRAMAR, FL
33025-5090

Practice Phone: 754-244-5808
Practice Fax: 305-676-9040

Directions to “ GIMENA ERMELINDA LOPEZ ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.