Provider Demographics
NPI:1750643359
Name:LOPEZ, GISELA (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9773 DARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5831
Mailing Address - Country:US
Mailing Address - Phone:917-822-8630
Mailing Address - Fax:
Practice Address - Street 1:9773 DARLINGTON PL
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5831
Practice Address - Country:US
Practice Address - Phone:917-822-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist