Provider Demographics
NPI:1619672953
Name:LOPEZ, SABRINA MAGGIE
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MAGGIE
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 1:6910 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2392
Mailing Address - Country:US
Mailing Address - Phone:417-619-1240
Mailing Address - Fax:
Practice Address - Street 1:6910 GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-2392
Practice Address - Country:US
Practice Address - Phone:417-619-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL120-793-90-760-0171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator