Provider Demographics
NPI:1255109963
Name:BORGES LOPEZ, DANIELA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BORGES 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 1:10825 SW 88TH ST APT 240
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1383
Mailing Address - Country:US
Mailing Address - Phone:786-458-5748
Mailing Address - Fax:
Practice Address - Street 1:4102 NARCISSUS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3467
Practice Address - Country:US
Practice Address - Phone:786-973-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-311857106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician