Provider Demographics
NPI:1447634621
Name:LOPEZ, MAIKEL
Entity type:Individual
Prefix:
First Name:MAIKEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 SW 132ND CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6456
Mailing Address - Country:US
Mailing Address - Phone:786-871-1699
Mailing Address - Fax:786-429-1808
Practice Address - Street 1:12350 SW 132ND CT
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6456
Practice Address - Country:US
Practice Address - Phone:786-871-1699
Practice Address - Fax:786-429-1808
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty