Healthcare Provider Details

I. General information

NPI: 1104010875
Provider Name (Legal Business Name): MIGUEL A LOPEZ-VIEGO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SOUTH SEACREST BOULEVARD SUITE 200
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

2800 SEACREST BOULEVARD SUITE 200
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-736-8200
  • Fax: 561-853-1608
Mailing address:
  • Phone: 561-736-8200
  • Fax: 561-853-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0062294
License Number StateFL

VIII. Authorized Official

Name: DR. MIGUEL ANGEL LOPEZ-VIEGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-736-8200