Provider Demographics
NPI:1659945855
Name:MOLINA LOPEZ, DAGMARIS (RBT)
Entity Type:Individual
Prefix:
First Name:DAGMARIS
Middle Name:
Last Name:MOLINA LOPEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 INDIAN TRACE CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1153
Mailing Address - Country:US
Mailing Address - Phone:856-345-4017
Mailing Address - Fax:
Practice Address - Street 1:1012 INDIAN TRACE CIR APT 104
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1153
Practice Address - Country:US
Practice Address - Phone:856-345-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician