Provider Demographics
NPI:1336563394
Name:LOPEZ, ANA C (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18738 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2430
Mailing Address - Country:US
Mailing Address - Phone:347-886-2116
Mailing Address - Fax:954-505-7561
Practice Address - Street 1:2955 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3205
Practice Address - Country:US
Practice Address - Phone:305-444-9259
Practice Address - Fax:305-445-3073
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist