Provider Demographics
NPI:1205475803
Name:LOPEZ, KENDY KARENYS
Entity type:Individual
Prefix:
First Name:KENDY
Middle Name:KARENYS
Last Name: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 1:18324 STREAMSIDE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5228
Mailing Address - Country:US
Mailing Address - Phone:240-543-8977
Mailing Address - Fax:
Practice Address - Street 1:18324 STREAMSIDE DR APT 204
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5228
Practice Address - Country:US
Practice Address - Phone:240-543-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19-239246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant