Estrada Lopez, Jacqueline

Estrada Lopez, Jacqueline is an sole proprietor health care provider with primary practice located at 3536 Tuloma Ter , North Port FL 34286-1110. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Estrada Lopez, Jacqueline can be contacted via phone (813) 528-7048.

Contact Information

Primary practice address
3536 Tuloma Ter North Port FL 34286-1110
Phone: (813) 528-7048
Fax: (855) 610-2343
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X

Profile Details

NPI number 1578936506
LBN Legal business name Estrada Lopez, Jacqueline
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 13th, 2015
Last updated Sep 22nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578936506 NPPES
Florida MEDICAID 017567300

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