Provider Demographics
NPI:1538635867
Name:LOPEZ, CORIN NICOLE
Entity Type:Individual
Prefix:
First Name:CORIN
Middle Name:NICOLE
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 1:1925 SW 107TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7347
Mailing Address - Country:US
Mailing Address - Phone:305-205-0314
Mailing Address - Fax:
Practice Address - Street 1:1925 SW 107TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7347
Practice Address - Country:US
Practice Address - Phone:305-205-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI37702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant