Provider Demographics
NPI:1104361294
Name:LOPES, RENATA
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:LOPES
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 1:10567 SLEEPY BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5737
Mailing Address - Country:US
Mailing Address - Phone:954-857-1236
Mailing Address - Fax:
Practice Address - Street 1:10567 SLEEPY BROOK WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5737
Practice Address - Country:US
Practice Address - Phone:954-857-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other