Provider Demographics
NPI:1629340112
Name:LOPEZ CULI, ANA MARY O (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANA MARY
Middle Name:O
Last Name:LOPEZ CULI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LONE PINE ST
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5741
Mailing Address - Country:US
Mailing Address - Phone:352-382-0943
Mailing Address - Fax:
Practice Address - Street 1:69 LONE PINE ST
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5741
Practice Address - Country:US
Practice Address - Phone:352-382-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist