MEDICARE: YAQUELIN SOSA 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	106S00000X	Behavior Technician	25-437414	FL

General Provider Information

NPI Number	:	1770477333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAQUELIN SOSA LOPEZ

Provider Business Mailing Address
First Line	:	7885 W 29TH LN APT 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5164
Country	:	US
Telephone Number	:	954-605-8495
Fax Number	:

Provider Business Practice Location Address
First Line	:	7885 W 29TH LN APT 102
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5164
Country	:	US
Telephone Number	:	954-605-8495
Fax Number	:

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

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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Directions to “ YAQUELIN SOSA LOPEZ ” Practice Location

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