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NPI Code Detail

MEDICARE: GABRIELLE LOPEZ

MEDICARE: GABRIELLE 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
1390200000XStudent in an Organized Health Care Education/Training ProgramKY

General Provider Information

NPI Number : 1558204412
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE LOPEZ
Provider Business Mailing Address
First Line : 18620 RAYMOND RD
Second Line :
City : MARYSVILLE
State : OH
Zip : 43040-7013
Country : US
Telephone Number : 813-919-5054
Fax Number :
Provider Business Practice Location Address
First Line : 2050 VERSAILLES RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-1405
Country : US
Telephone Number : 859-257-4888
Fax Number : 859-323-1123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ GABRIELLE LOPEZ ” Practice Location

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