Healthcare Provider Details

I. General information

NPI: 1508354861
Provider Name (Legal Business Name): DIEGO JOSE LOPES DE LIMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MILITARY TRL STE 105
JUPITER FL
33458-5700
US

IV. Provider business mailing address

10131 FOREST HILL BLVD STE 230
WELLINGTON FL
33414-6109
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-6600
  • Fax: 561-753-3328
Mailing address:
  • Phone: 561-798-6600
  • Fax: 561-753-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME146444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: