MEDICARE: DAGMARIS MOLINA LOPEZ RBT, ITDS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659945855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAGMARIS MOLINA LOPEZ RBT, ITDS

Provider Business Mailing Address
First Line	:	4190 BENT RIVER RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-8604
Country	:	US
Telephone Number	:	856-345-4017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 INDIAN TRACE CIR APT 104
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1153
Country	:	US
Telephone Number	:	856-345-4017
Fax Number	:

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

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	10/14/2024

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