MEDICARE: INGRID VIRGINIA 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
2	106S00000X	Behavior Technician	RBT-15-06679	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	:	1275776064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID VIRGINIA LOPEZ

Provider Business Mailing Address
First Line	:	18151 NE 31ST CT APT 2016
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33160-2666
Country	:	US
Telephone Number	:	786-709-8397
Fax Number	:

Provider Business Practice Location Address
First Line	:	18151 NE 31ST CT APT 2016
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33160-2666
Country	:	US
Telephone Number	:	786-709-8397
Fax Number	:

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	03/11/2026

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Directions to “ INGRID VIRGINIA LOPEZ ” Practice Location

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