Provider Demographics
NPI:1215714498
Name:LOPEZ MENDEZ, JENNY (CC)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:LOPEZ MENDEZ
Suffix:
Gender:F
Credentials:CC
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARE COACH
Mailing Address - Street 1:600 NE 22ND TER STE 304
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4715
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:866-255-3886
Practice Address - Street 1:600 NE 22ND TER STE 304
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4715
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:866-255-3886
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18820171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach