Provider Demographics
NPI:1669101630
Name:PEREZ LOPEZ, NOEMI (ITDS)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:PEREZ LOPEZ
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 NW 134TH WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3688
Mailing Address - Country:US
Mailing Address - Phone:352-672-0359
Mailing Address - Fax:
Practice Address - Street 1:476 NW 134TH WAY APT 308
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3688
Practice Address - Country:US
Practice Address - Phone:352-672-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty