Provider Demographics
NPI:1114384377
Name:LOPEZ, IVONNE
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name: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 1:10585 SW 109TH CT STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3309
Mailing Address - Country:US
Mailing Address - Phone:786-445-1335
Mailing Address - Fax:
Practice Address - Street 1:10585 SW 109TH CT STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3309
Practice Address - Country:US
Practice Address - Phone:786-655-0854
Practice Address - Fax:786-655-0890
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst