Provider Demographics
NPI:1093282873
Name:NARANJO LOPEZ, INDIRAH
Entity Type:Individual
Prefix:
First Name:INDIRAH
Middle Name:
Last Name:NARANJO LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5157
Mailing Address - Country:US
Mailing Address - Phone:786-294-5825
Mailing Address - Fax:
Practice Address - Street 1:4100 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5157
Practice Address - Country:US
Practice Address - Phone:786-294-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022424600Medicaid