Provider Demographics
NPI:1720683527
Name:LOPEZ, KIMBERLY (BA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 SWIFT FOX TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2650
Mailing Address - Country:US
Mailing Address - Phone:813-766-8558
Mailing Address - Fax:
Practice Address - Street 1:3218 SWIFT FOX TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2650
Practice Address - Country:US
Practice Address - Phone:813-766-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator