Provider Demographics
NPI:1770346629
Name:LOPEZ, DAYANETH YOLANDA
Entity type:Individual
Prefix:
First Name:DAYANETH
Middle Name:YOLANDA
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 1:950 S GEORGE MASON DR APT 503
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1790
Mailing Address - Country:US
Mailing Address - Phone:919-418-4349
Mailing Address - Fax:
Practice Address - Street 1:4560 CRAIN HWY STE 11
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3084
Practice Address - Country:US
Practice Address - Phone:240-210-9725
Practice Address - Fax:240-366-1161
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered