MEDICARE: EUGENIA CAROLINA 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	2355S0801X	Speech-Language Assistant	SI6181	FL

General Provider Information

NPI Number	:	1952169997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA CAROLINA LOPEZ

Provider Business Mailing Address
First Line	:	2861 W 76TH ST APT 202
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-8303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 W 76TH ST APT 202
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-8303
Country	:	US
Telephone Number	:	786-813-6048
Fax Number	:

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

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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Directions to “ EUGENIA CAROLINA LOPEZ ” Practice Location

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