Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | FL |
NPI | 1114467743 |
---|---|
Provider Name | Odalis Lopez |
First Address | Miami, FL 33144-4100 |
Second Address | Miami, FL 33144-4100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2017 |
Last Update Date | 01/03/2017 |