Provider Demographics
NPI:1982913570
Name:LOPEZ, ONEL (MA)
Entity Type:Individual
Prefix:
First Name:ONEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SIDONIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3436
Mailing Address - Country:US
Mailing Address - Phone:786-231-8414
Mailing Address - Fax:
Practice Address - Street 1:30 SIDONIA AVE APT 1
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3436
Practice Address - Country:US
Practice Address - Phone:786-231-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59442225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist