Provider Demographics
NPI:1346838034
Name:LOPEZ, VILMA
Entity Type:Individual
Prefix:
First Name:VILMA
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 1:1126 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7079
Mailing Address - Country:US
Mailing Address - Phone:407-497-5463
Mailing Address - Fax:
Practice Address - Street 1:1126 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7079
Practice Address - Country:US
Practice Address - Phone:407-497-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL853024084Medicaid
FL853024084OtherMEDICAL TRANSPORTATION