MEDICARE: ASHLEY 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	156F00000X	Technician/Technologist		FL

General Provider Information

NPI Number	:	1457293425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LOPEZ

Provider Business Mailing Address
First Line	:	580 VERIDIAN CIR NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 VERIDIAN CIR NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8035
Country	:	US
Telephone Number	:	352-222-1660
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ ASHLEY LOPEZ ” Practice Location

Language	Start Address	Practice Location

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