Provider Demographics
NPI:1598201550
Name:LOPEZ, DAIHAMI
Entity Type:Individual
Prefix:
First Name:DAIHAMI
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 1:2985 W 80TH ST APT 119
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3837
Mailing Address - Country:US
Mailing Address - Phone:786-663-7490
Mailing Address - Fax:
Practice Address - Street 1:2985 W 80TH ST APT 119
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-3837
Practice Address - Country:US
Practice Address - Phone:786-663-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019744900Medicaid