Doctor Name: | JUAN J LOPEZ |
NPI Number: | 1144244328 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | SS648 |
Business Practice Address: | 101 E Maud St Tavares, FL - 327783249 |
Business Phone Number: | 3522539348 |
Business Fax Number: | 3522539351 |
Mailing Address: | 101 E Maud St, TAVARES |
State: | FL |
Postal Code: | 327783249 |
Phone Number: | 3522539348 |
Fax Number: | 3522539351 |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | SS648 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |