Doctor Name: | BENJAMIN LOPEZ |
NPI Number: | 1023368511 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 19176 |
Business Practice Address: | 4764 Vero Beach Pl Kissimmee, FL - 347467412 |
Business Phone Number: | 7874601798 |
Business Fax Number: | |
Mailing Address: | 4764 Vero Beach Pl, KISSIMMEE |
State: | FL |
Postal Code: | 347467412 |
Phone Number: | 7874601798 |
Fax Number: | |
NPI Enumeration Date: | 09/12/2012 |
NPI Last Update Date: | 09/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 19176 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |