Provider Demographics
NPI:1891313318
Name:PEREZ LOPEZ, LIEN
Entity Type:Individual
Prefix:MS
First Name:LIEN
Middle Name:
Last Name:PEREZ 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 1:1050 NW 44TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2531
Mailing Address - Country:US
Mailing Address - Phone:214-869-0465
Mailing Address - Fax:
Practice Address - Street 1:1050 NW 44TH AVE APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2531
Practice Address - Country:US
Practice Address - Phone:214-869-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-121294106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician