Provider Demographics
NPI:1740706456
Name:LOPEZ, CECILIA DINAY
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:DINAY
Last Name: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 1:10902 NW 83RD ST APT 220
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1725
Mailing Address - Country:US
Mailing Address - Phone:347-533-1359
Mailing Address - Fax:
Practice Address - Street 1:10902 NW 83RD ST APT 220
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1725
Practice Address - Country:US
Practice Address - Phone:305-417-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty