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NPI Code Detail

MEDICARE: MICHELLE LOPEZ

MEDICARE: MICHELLE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1316484090
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LOPEZ
Provider Business Mailing Address
First Line : 6713 NW 192ND TER
Second Line :
City : HIALEAH
State : FL
Zip : 33015-2456
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12051 W OKEECHOBEE RD
Second Line :
City : HIALEAH
State : FL
Zip : 33018-2933
Country : US
Telephone Number : 305-828-5276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2017
Last Update Date : 02/06/2018

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Directions to “ MICHELLE LOPEZ ” Practice Location

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