1366097628 NPI number — NEW DAY SPEECH THERAPY SERVICES LLC

Table of content: DR. KEVIN MARC LOPEZ D.C. (NPI 1053634717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366097628 NPI number — NEW DAY SPEECH THERAPY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DAY SPEECH THERAPY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366097628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2180 A1A S STE 104
Provider Second Line Business Mailing Address:
DEPREY CHIROPRACTIC BUILDING
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32080-6523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-377-7947
Provider Business Mailing Address Fax Number:
904-471-6236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 A1A S STE 104
Provider Second Line Business Practice Location Address:
DEPREY CHIROPRACTIC BUILDING
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32080-6523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-377-7947
Provider Business Practice Location Address Fax Number:
904-471-6236
Provider Enumeration Date:
08/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SMALLWOOD
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-377-7947

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104119700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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