Provider Demographics
NPI:1073545372
Name:LOPEZ, HILDA M (PHD)
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6269 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4908
Mailing Address - Country:US
Mailing Address - Phone:786-389-0432
Mailing Address - Fax:305-456-3886
Practice Address - Street 1:1923 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3315
Practice Address - Country:US
Practice Address - Phone:786-389-0432
Practice Address - Fax:305-456-3886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4869103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBL628ZMedicare PIN
FL59543ZMedicare PIN