Provider Demographics
NPI:1235306333
Name:LOPEZ, VERONICA (MT)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 23RD AVE
Mailing Address - Street 2:APT. 1809
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-6238
Mailing Address - Country:US
Mailing Address - Phone:352-390-6158
Mailing Address - Fax:
Practice Address - Street 1:100 NW 23RD AVE
Practice Address - Street 2:APT. 1809
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6238
Practice Address - Country:US
Practice Address - Phone:352-390-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 48387172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker