Provider Demographics
NPI:1518475565
Name:TAMAYO LOPEZ, VICTOR HUGO
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:TAMAYO LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4894
Mailing Address - Country:US
Mailing Address - Phone:305-335-4413
Mailing Address - Fax:
Practice Address - Street 1:1275 W 35TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4894
Practice Address - Country:US
Practice Address - Phone:305-335-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician