Provider Demographics
NPI:1750842001
Name:LOPEZ, CRYSTAL ANGELICA
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ANGELICA
Last Name:LOPEZ
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 1:501 PACITO WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7088
Mailing Address - Country:US
Mailing Address - Phone:407-404-2684
Mailing Address - Fax:
Practice Address - Street 1:501 PACITO WAY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7088
Practice Address - Country:US
Practice Address - Phone:407-404-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor