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NPI Code Detail

MEDICARE: SANDRA LOPEZ BS

MEDICARE: SANDRA LOPEZ BS
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
1104100000XSocial Worker
2171M00000XCase Manager/Care CoordinatorCBHCMS100001FL

General Provider Information

NPI Number : 1265690473
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA LOPEZ BS
Provider Business Mailing Address
First Line : 11031 NE 6TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33161-7182
Country : US
Telephone Number : 305-398-6100
Fax Number : 305-757-4465
Provider Business Practice Location Address
First Line : 4215 SW 72ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33155-4510
Country : US
Telephone Number : 305-377-3297
Fax Number : 305-377-3854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2008
Last Update Date : 01/19/2021

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