Healthcare Provider Details

I. General information

NPI: 1821812355
Provider Name (Legal Business Name): AQUIANY LOPEZ NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE EL MORRO 44, PUERTO PLATA
PUERTO PLATA DOMINICAN REPUBLIC
57000
DO

IV. Provider business mailing address

2007 E 23RD AVE
TAMPA FL
33605-1929
US

V. Phone/Fax

Practice location:
  • Phone: 809-891-9227
  • Fax:
Mailing address:
  • Phone: 972-330-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number228729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: