MEDICARE: DANIEL 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	225700000X	Massage Therapist	MA78587	FL

General Provider Information

NPI Number	:	1619581113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LOPEZ

Provider Business Mailing Address
First Line	:	3061 SANDPIPER BAY CIR APT J305
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-5502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 SANDPIPER BAY CIR APT J305
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-5502
Country	:	US
Telephone Number	:	239-250-1000
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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Directions to “ DANIEL LOPEZ ” Practice Location

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