MEDICARE: ANILIN LOPEZ GONZALEZ APRN

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	363A00000X	Physician Assistant	000288-PA	PR
2	363L00000X	Nurse Practitioner	APRN11037144	FL

General Provider Information

NPI Number	:	1881213247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANILIN LOPEZ GONZALEZ APRN

Provider Business Mailing Address
First Line	:	7119 W 13TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4514
Country	:	US
Telephone Number	:	786-523-6263
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 W 13TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4514
Country	:	US
Telephone Number	:	786-523-6263
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	01/14/2025

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