Healthcare Provider Details

I. General information

NPI: 1972796514
Provider Name (Legal Business Name): FAMILY &PEDIATRIC MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 NW 82ND AVE STE 102
DORAL FL
33122-1056
US

IV. Provider business mailing address

3155 NW 82ND AVE STE 102
DORAL FL
33122-1056
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-2988
  • Fax: 305-591-2995
Mailing address:
  • Phone: 305-591-2988
  • Fax: 305-591-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILSON LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-591-2988