Provider Demographics
NPI:1114513546
Name:LOPEZ, SOL ANGEL (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:SOL
Middle Name:ANGEL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:SOL
Other - Middle Name:ANGEL
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10820 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3412
Mailing Address - Country:US
Mailing Address - Phone:786-352-7826
Mailing Address - Fax:
Practice Address - Street 1:450 N PARK RD STE 400
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6918
Practice Address - Country:US
Practice Address - Phone:954-925-3191
Practice Address - Fax:954-925-3193
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician