Provider Demographics
NPI:1093308561
Name:LOPEZ IZAGUIRRE, YUKIE (TCM)
Entity Type:Individual
Prefix:
First Name:YUKIE
Middle Name:
Last Name:LOPEZ IZAGUIRRE
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18120 NW 59TH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5219
Mailing Address - Country:US
Mailing Address - Phone:786-832-5277
Mailing Address - Fax:
Practice Address - Street 1:18120 NW 59TH AVE APT 206
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5219
Practice Address - Country:US
Practice Address - Phone:786-832-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator