Provider Demographics
NPI:1639336605
Name:CIUFO-LOPEZ, PATRIZIA F (OTRL)
Entity Type:Individual
Prefix:
First Name:PATRIZIA
Middle Name:F
Last Name:CIUFO-LOPEZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 VILLAGE DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2961
Mailing Address - Country:US
Mailing Address - Phone:561-900-6254
Mailing Address - Fax:561-498-0733
Practice Address - Street 1:3975 VILLAGE DR
Practice Address - Street 2:UNIT D
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2961
Practice Address - Country:US
Practice Address - Phone:561-900-6254
Practice Address - Fax:561-498-0733
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6885171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT 6885OtherOT LICENSE