Provider Demographics
NPI:1144106881
Name:LOPEZ MUZICO, NATHALIA JULIANA
Entity type:Individual
Prefix:
First Name:NATHALIA
Middle Name:JULIANA
Last Name:LOPEZ MUZICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 NW 37TH ST APT 401
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5986
Mailing Address - Country:US
Mailing Address - Phone:320-295-6437
Mailing Address - Fax:
Practice Address - Street 1:5731 NW 37TH ST APT 401
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-5986
Practice Address - Country:US
Practice Address - Phone:320-295-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician