Provider Demographics
NPI:1598205049
Name:LOPEZ, MONICA (BS)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13396 SW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4328
Mailing Address - Country:US
Mailing Address - Phone:305-878-9820
Mailing Address - Fax:
Practice Address - Street 1:5226 SW 90TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6633
Practice Address - Country:US
Practice Address - Phone:305-878-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10464235Z00000X
FLSA20740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist