Healthcare Provider Details

I. General information

NPI: 1770991341
Provider Name (Legal Business Name): ZULMA LOPEZ RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 SR 20 STE 100
INTERLACHEN FL
32148
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 386-684-0195
  • Fax: 386-684-0229
Mailing address:
  • Phone: 904-293-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1778
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18795
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: