Provider Demographics
NPI:1508649336
Name:LOPEZ FRANCO, MARYMAR
Entity Type:Individual
Prefix:
First Name:MARYMAR
Middle Name:
Last Name:LOPEZ FRANCO
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 1:3000 CAMBER DR APT 303
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7214
Mailing Address - Country:US
Mailing Address - Phone:939-245-7306
Mailing Address - Fax:
Practice Address - Street 1:435 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6627
Practice Address - Country:US
Practice Address - Phone:407-219-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician