Provider Demographics
NPI:1023453073
Name:LOPEZ-GOLDSTEIN, SOCORRO LILIANA (COTA)
Entity type:Individual
Prefix:
First Name:SOCORRO
Middle Name:LILIANA
Last Name:LOPEZ-GOLDSTEIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 W 131ST PL APT 412
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-5134
Mailing Address - Country:US
Mailing Address - Phone:702-813-3329
Mailing Address - Fax:
Practice Address - Street 1:6700 ANTIOCH RD STE 120
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-1200
Practice Address - Country:US
Practice Address - Phone:888-652-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00895224Z00000X
MO2013009029224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant