Provider Demographics
NPI:1497574966
Name:LOPEZ, DESTINY
Entity type:Individual
Prefix:MS
First Name:DESTINY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7059 WEST BLVD APT 225
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4332
Mailing Address - Country:US
Mailing Address - Phone:330-553-0418
Mailing Address - Fax:
Practice Address - Street 1:7059 WEST BLVD APT 225
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4332
Practice Address - Country:US
Practice Address - Phone:330-553-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide