Provider Demographics
NPI:1144688466
Name:LOPEZ, JOHANNA (RDN)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:LOPEZ CIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:1323 SE 17TH ST
Mailing Address - Street 2:PMB 100065
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:786-973-2363
Mailing Address - Fax:
Practice Address - Street 1:1323 SE 17TH ST
Practice Address - Street 2:PMB 100065
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:786-973-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCDR 86017854133V00000X
FLND7671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered