MEDICARE: DIANA CAROLINA 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

General Provider Information

NPI Number	:	1598046187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CAROLINA LOPEZ

Provider Business Mailing Address
First Line	:	710 NE 142ND ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 NE 142ND ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3238
Country	:	US
Telephone Number	:	305-984-8372
Fax Number	:

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

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	09/08/2011

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Directions to “ DIANA CAROLINA LOPEZ ” Practice Location

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