Provider Demographics
NPI:1871844837
Name:LOPEZ PEREZ, AINALEZ (MS)
Entity Type:Individual
Prefix:
First Name:AINALEZ
Middle Name:
Last Name:LOPEZ PEREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 ANTICA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-1500
Mailing Address - Country:US
Mailing Address - Phone:239-849-0509
Mailing Address - Fax:
Practice Address - Street 1:3348 ANTICA ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-1500
Practice Address - Country:US
Practice Address - Phone:239-849-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5511235Z00000X
NC152259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist