MEDICARE: VIVIANA 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		FL
2	106S00000X	Behavior Technician	L120-860-71-672-0	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861904393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA LOPEZ

Provider Business Mailing Address
First Line	:	3822 SW 136TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3230
Country	:	US
Telephone Number	:	786-267-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3822 SW 136TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3230
Country	:	US
Telephone Number	:	786-267-3077
Fax Number	:

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	11/14/2021

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Directions to “ VIVIANA LOPEZ ” Practice Location

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