Provider Demographics
NPI:1750044517
Name:LOPEZ MARIN, NAYLET
Entity Type:Individual
Prefix:
First Name:NAYLET
Middle Name:
Last Name:LOPEZ MARIN
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 1:467 LAKE HOWELL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5922
Mailing Address - Country:US
Mailing Address - Phone:407-449-2813
Mailing Address - Fax:
Practice Address - Street 1:467 LAKE HOWELL RD STE 102
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5922
Practice Address - Country:US
Practice Address - Phone:407-449-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-185371106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician