Provider Demographics
NPI:1851980064
Name:HILLIARD-LOPEZ, REESHA LYNN (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:REESHA
Middle Name:LYNN
Last Name:HILLIARD-LOPEZ
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:MRS
Other - First Name:REESHA
Other - Middle Name:LYNN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:13916 JACOBSON DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1762
Mailing Address - Country:US
Mailing Address - Phone:813-522-0086
Mailing Address - Fax:
Practice Address - Street 1:13916 JACOBSON DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1762
Practice Address - Country:US
Practice Address - Phone:813-522-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty