MEDICARE: 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	BCBA1-25-86672	FL

General Provider Information

NPI Number	:	1649006693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA LOPEZ

Provider Business Mailing Address
First Line	:	3355 W 68TH ST APT 161
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-1743
Country	:	US
Telephone Number	:	786-830-5123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 W 68TH ST APT 161
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-1743
Country	:	US
Telephone Number	:	786-830-5123
Fax Number	:

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

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	01/07/2026

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Directions to “ CAROLINA LOPEZ ” Practice Location

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