Provider Demographics
NPI:1124381546
Name:LOPEZ, ISIS OSULI
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:OSULI
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 1:54 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4842
Mailing Address - Country:US
Mailing Address - Phone:786-401-7818
Mailing Address - Fax:786-431-1065
Practice Address - Street 1:54 E 5TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4842
Practice Address - Country:US
Practice Address - Phone:786-401-7818
Practice Address - Fax:786-431-1065
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker