Individual
LUIS WILFREDO LOPEZ-RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLP
Contact information
Practice address
725 N 12TH AVE BLDG B, ARCADIA, FL 34266-8752
(417) 761-5000
Mailing address
101 RIVERFRONT BLVD STE 710, BRADENTON, FL 34205-8812
(941) 776-4000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
2020030184
MO
103TC0700X
Clinical Psychologist
PY11347
FL
Other
Enumeration date
03/09/2020
Last updated
02/17/2023
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