Individual
MARICEL NOEMI LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
200 HIGH PARK AVE, GOSHEN, IN 46526-4810
(574) 364-2868
Mailing address
14070 KIMBERLY LN, MIDDLEBURY, IN 46540-9727
(574) 612-7563
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1096964
IN
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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