Provider Demographics
NPI:1578393096
Name:LOPEZ LOPEZ, KATHERINE JULISSA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JULISSA
Last Name:LOPEZ LOPEZ
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 1:22000 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1230
Mailing Address - Country:US
Mailing Address - Phone:786-205-4402
Mailing Address - Fax:
Practice Address - Street 1:22000 SW 93RD PL
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1230
Practice Address - Country:US
Practice Address - Phone:786-205-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program