MEDICARE: ESTHERMARIE LOPEZ-GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	35.153452	OH

General Provider Information

NPI Number	:	1245883842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHERMARIE LOPEZ-GONZALEZ

Provider Business Mailing Address
First Line	:	PO BOX 7004
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-7004
Country	:	US
Telephone Number	:	787-840-2575
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2347
Country	:	US
Telephone Number	:	330-603-5325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	06/03/2025

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