Provider Demographics
NPI:1679892970
Name:LOPEZ, MAYDA V (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MAYDA
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 SANTA ANA ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3338
Mailing Address - Country:US
Mailing Address - Phone:407-873-0983
Mailing Address - Fax:
Practice Address - Street 1:214 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4535
Practice Address - Country:US
Practice Address - Phone:407-575-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA183851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse