Provider Demographics
NPI:1205574977
Name:LOPEZ, REBECCA
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
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 1:98 SHOREVIEW DR APT 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1348
Mailing Address - Country:US
Mailing Address - Phone:914-308-4459
Mailing Address - Fax:
Practice Address - Street 1:98 SHOREVIEW DR APT 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1348
Practice Address - Country:US
Practice Address - Phone:914-308-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2532284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist