Provider Demographics
NPI:1922754795
Name:LOPEZ ROJAS, AMANDA LILIANA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LILIANA
Last Name:LOPEZ ROJAS
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 1:15702 E WATERSIDE CIR APT 206
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2206
Mailing Address - Country:US
Mailing Address - Phone:754-214-7071
Mailing Address - Fax:
Practice Address - Street 1:15702 E WATERSIDE CIR APT 206
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-2206
Practice Address - Country:US
Practice Address - Phone:754-214-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No374J00000XNursing Service Related ProvidersDoula