Provider Demographics
NPI:1952662652
Name:LOPEZ, MARIA GABRIELA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:GABRIELA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 SW 150TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1418
Mailing Address - Country:US
Mailing Address - Phone:305-298-0720
Mailing Address - Fax:
Practice Address - Street 1:13590 SW 134TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-732-6646
Practice Address - Fax:786-842-3218
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI11002355S0801X
FLSA12716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590668488OtherPRIVATE