Healthcare Provider Details

I. General information

NPI: 1063916047
Provider Name (Legal Business Name): ANNE LOPEZ ASHOURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE LOPEZ MD

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

9331 GRAND PRIX LN
BOYNTON BEACH FL
33472-2783
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1014755
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME154422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: