Healthcare Provider Details

I. General information

NPI: 1477473262
Provider Name (Legal Business Name): LOPEZ FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 NW 186TH ST APT 103
HIALEAH FL
33015-3318
US

IV. Provider business mailing address

6700 NW 186TH ST APT 103
HIALEAH FL
33015-3318
US

V. Phone/Fax

Practice location:
  • Phone: 305-301-9009
  • Fax:
Mailing address:
  • Phone: 305-301-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANDOR LOPEZ FIGUEREDO
Title or Position: OWNER AND AUTHORIZED OFFICIAL
Credential:
Phone: 305-301-9009