Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003056813 |
---|---|
Provider Name | Lydia Milixza Lopez |
First Address | Tampa, FL 33612-3803 |
Second Address | Tampa, FL 33612-3803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2009 |
Last Update Date | 06/03/2009 |