MEDICARE: TATIANA LOPEZ DUENAS

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-23-309964	FL

General Provider Information

NPI Number	:	1871359927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA LOPEZ DUENAS

Provider Business Mailing Address
First Line	:	3307 SE 15TH PL APT 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7240
Country	:	US
Telephone Number	:	239-677-1102
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 SE 15TH PL APT 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7240
Country	:	US
Telephone Number	:	239-677-1102
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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Directions to “ TATIANA LOPEZ DUENAS ” Practice Location

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