MEDICARE: YENEY LOPEZ MARQUEZ

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	RBT-20-138034	FL

General Provider Information

NPI Number	:	1710764345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENEY LOPEZ MARQUEZ

Provider Business Mailing Address
First Line	:	21419 SW 88TH AVE
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21419 SW 88TH AVE
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3767
Country	:	US
Telephone Number	:	305-984-9302
Fax Number	:

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

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	09/08/2023

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