MEDICARE: MR. YADIAN 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	103K00000X	Behavior Analyst	RBT-20-129070	FL

General Provider Information

NPI Number	:	1558242321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YADIAN LOPEZ

Provider Business Mailing Address
First Line	:	14247 SW 156TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6071
Country	:	US
Telephone Number	:	786-508-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	14247 SW 156TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6071
Country	:	US
Telephone Number	:	786-508-8880
Fax Number	:

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

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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