Individual
BRENDA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 S MILLER ST # 1, NEWBURGH, NY 12550-4907
(845) 654-3030
Mailing address
12 S MILLER ST # 1, NEWBURGH, NY 12550-4907
(845) 654-3030
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
264763072
NY
Other
Enumeration date
12/27/2021
Last updated
06/29/2022
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