Healthcare Provider Details

I. General information

NPI: 1568659514
Provider Name (Legal Business Name): SANDRA MARIA PIZARRO LOPEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax: 407-975-0413
Mailing address:
  • Phone: 407-975-0412
  • Fax: 407-975-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128913
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97028
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME128913
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17135
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: