Provider Demographics
NPI:1639978976
Name:LOPEZ SORIANO, RUBIDIA DEL CARMEN I (WORK PERMIT CARD)
Entity type:Individual
Prefix:MS
First Name:RUBIDIA
Middle Name:DEL CARMEN
Last Name:LOPEZ SORIANO
Suffix:I
Gender:
Credentials:WORK PERMIT CARD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 NW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2732
Mailing Address - Country:US
Mailing Address - Phone:954-469-3283
Mailing Address - Fax:
Practice Address - Street 1:4330 NW 60TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319-2732
Practice Address - Country:US
Practice Address - Phone:954-469-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician