Healthcare Provider Details

I. General information

NPI: 1700023074
Provider Name (Legal Business Name): HERIBERTO LOPEZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S PARK RD STE 200
HOLLYWOOD FL
33021-8541
US

IV. Provider business mailing address

12628 SW 21ST ST
MIRAMAR FL
33027-2601
US

V. Phone/Fax

Practice location:
  • Phone: 888-986-2263
  • Fax:
Mailing address:
  • Phone: 239-692-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11021791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: