Healthcare Provider Details

I. General information

NPI: 1568371466
Provider Name (Legal Business Name): SAURIE NAHIR ROMAN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20626 W SILVER PALM DR
ESTERO FL
33928-3478
US

IV. Provider business mailing address

20626 W SILVER PALM DR
ESTERO FL
33928-3478
US

V. Phone/Fax

Practice location:
  • Phone: 239-428-5067
  • Fax:
Mailing address:
  • Phone: 239-428-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPS65198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: