Provider Demographics
NPI:1679374680
Name:LOPEZ SILVA, MARITZA
Entity type:Individual
Prefix:MISS
First Name:MARITZA
Middle Name:
Last Name:LOPEZ SILVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 NANTUCKET CIR APT A
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2111
Mailing Address - Country:US
Mailing Address - Phone:561-856-8903
Mailing Address - Fax:
Practice Address - Street 1:738 NANTUCKET CIR APT A
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2111
Practice Address - Country:US
Practice Address - Phone:561-856-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL124-540-65-868-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver