Provider Demographics
NPI:1912773565
Name:MOGENA LOPEZ, YOAN DANIEL (SA-C)
Entity Type:Individual
Prefix:
First Name:YOAN
Middle Name:DANIEL
Last Name:MOGENA LOPEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 SW 135TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3367
Mailing Address - Country:US
Mailing Address - Phone:321-387-3478
Mailing Address - Fax:
Practice Address - Street 1:10600 SW 135TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3367
Practice Address - Country:US
Practice Address - Phone:321-387-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-710246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant