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Individual

ALEJANDRA LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3006 SE 18TH AVE, CAPE CORAL, FL 33904-4009
(239) 330-2403
Mailing address
3006 SE 18TH AVE, CAPE CORAL, FL 33904-4009
(239) 330-2403

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
82-205674
TAX ID
FL
Enumeration date
07/05/2017
Last updated
06/16/2018
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