Provider Demographics
NPI:1467994160
Name:LOPEZ, ANABEL
Entity Type:Individual
Prefix:
First Name:ANABEL
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 1:8365 SW 152ND AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4033
Mailing Address - Country:US
Mailing Address - Phone:786-801-4186
Mailing Address - Fax:305-557-1287
Practice Address - Street 1:2100 W 76TH ST
Practice Address - Street 2:SUIT 211
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:786-801-4186
Practice Address - Fax:305-557-1287
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019739200Medicaid