Provider Demographics
NPI:1528404183
Name:LOPEZ, HENGINEY GABRIELA
Entity Type:Individual
Prefix:MISS
First Name:HENGINEY
Middle Name:GABRIELA
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 1:5755 W 20TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7546
Mailing Address - Country:US
Mailing Address - Phone:919-454-7792
Mailing Address - Fax:
Practice Address - Street 1:5755 W 20TH AVE APT 208
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7546
Practice Address - Country:US
Practice Address - Phone:919-454-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31724385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHGL0404OtherBEHAVIORAL HEALTH AND SOCIAL SERVICE PROVIDERS