MEDICARE: CARLOS OSMUNDO LOPEZ

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	225700000X	Massage Therapist	MA31783	FL

General Provider Information

NPI Number	:	1396187795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS OSMUNDO LOPEZ

Provider Business Mailing Address
First Line	:	2150 BAY DR APT 2
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3479
Country	:	US
Telephone Number	:	305-491-7715
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 BAY DR APT 2
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3479
Country	:	US
Telephone Number	:	305-491-7715
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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Directions to “ CARLOS OSMUNDO LOPEZ ” Practice Location

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