Individual
CARLOS LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2873 EXECUTIVE PARK DR, WESTON, FL 33331-3603
(754) 812-8700
Mailing address
2873 EXECUTIVE PARK DR, WESTON, FL 33331-3603
(754) 812-8700
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-50858
FL
106S00000X
Behavior Technician
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009093700
—
FL
Enumeration date
11/08/2013
Last updated
01/11/2022
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