Provider Demographics
NPI:1386200111
Name:LOPEZ, JULIO (RBT)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 NW 141ST TER APT 4001
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6721
Mailing Address - Country:US
Mailing Address - Phone:786-566-8243
Mailing Address - Fax:
Practice Address - Street 1:8402 NW 141ST TER APT 4001
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6721
Practice Address - Country:US
Practice Address - Phone:786-566-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician