MEDICARE: MRS. ADRIANA LOPEZ M.A.

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	235Z00000X	Speech-Language Pathologist	SA5731	FL

General Provider Information

NPI Number	:	1427277235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIANA LOPEZ M.A.

Provider Business Mailing Address
First Line	:	14301 SW 71ST LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2115
Country	:	US
Telephone Number	:	305-984-9715
Fax Number	:	305-382-5721

Provider Business Practice Location Address
First Line	:	14301 SW 71ST LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-2115
Country	:	US
Telephone Number	:	305-984-9715
Fax Number	:	305-382-5721

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/09/2007

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