Provider Demographics
NPI:1780786293
Name:LOPEZ-DELGADO, ICEL
Entity type:Individual
Prefix:
First Name:ICEL
Middle Name:
Last Name:LOPEZ-DELGADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:2300 W 84 TH STREET SUITE 105
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7182
Mailing Address - Country:US
Mailing Address - Phone:786-666-0507
Mailing Address - Fax:786-666-0419
Practice Address - Street 1:2300 W 84TH ST STE 105
Practice Address - Street 2:2300 W 84 TH STREET SUITE 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5771
Practice Address - Country:US
Practice Address - Phone:786-666-0507
Practice Address - Fax:786-666-0419
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor