MEDICARE: DR. LIDYA MARGARITA LATABAN-LOPEZ MD

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	208D00000X	General Practice Physician	15204	PR
2	208D00000X	General Practice Physician	ACN911	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ACN911	OTHER	FL	FLORIDA LICENSE
2	B159	OTHER	PR	FIRST MEDICAL
3	22385	OTHER	PR	TRIPLE S DE PUERTO RICO
4	9700031	OTHER	PR	HUMANA

General Provider Information

NPI Number	:	1275581829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIDYA MARGARITA LATABAN-LOPEZ MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 CYPRESS POINT PKWY STE A
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-7528
Country	:	US
Telephone Number	:	386-586-7005
Fax Number	:	844-867-3940

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/10/2024

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Directions to “ DR. LIDYA MARGARITA LATABAN-LOPEZ MD” Practice Location

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