Provider Demographics
NPI:1881461986
Name:LOPEZ RODRIGUEZ, LILIANA
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:LOPEZ RODRIGUEZ
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 1:2789 S FLORIDA MANGO RD APT 310
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2219
Mailing Address - Country:US
Mailing Address - Phone:561-303-8002
Mailing Address - Fax:
Practice Address - Street 1:2789 S FLORIDA MANGO RD APT 310
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2219
Practice Address - Country:US
Practice Address - Phone:561-303-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician