Provider Demographics
NPI:1679396964
Name:LOPEZ RODRIGUEZ, JESUS (CBHCM)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:LOPEZ RODRIGUEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14681 SW 108TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2962
Mailing Address - Country:US
Mailing Address - Phone:786-343-5270
Mailing Address - Fax:
Practice Address - Street 1:10520 NW 26TH ST STE C201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2161
Practice Address - Country:US
Practice Address - Phone:305-364-5182
Practice Address - Fax:305-456-6243
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management