Provider Demographics
NPI:1003981077
Name:LOPEZ, ADRIANA CECILIA (OTR)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:CECILIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:CECILIA
Other - Last Name:GUZMAN-LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:7516 NW 108TH PATH
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2250
Mailing Address - Country:US
Mailing Address - Phone:786-253-7211
Mailing Address - Fax:866-876-8278
Practice Address - Street 1:7516 NW 108TH PATH
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2250
Practice Address - Country:US
Practice Address - Phone:786-253-7211
Practice Address - Fax:866-876-8278
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890189900Medicaid