Healthcare Provider Details

I. General information

NPI: 1164042289
Provider Name (Legal Business Name): LORENA A LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6990 NW 186TH ST APT 403
HIALEAH FL
33015-3137
US

IV. Provider business mailing address

6990 NW 186TH ST APT 403
HIALEAH FL
33015-3137
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-2107
  • Fax:
Mailing address:
  • Phone: 305-364-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME161559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: