Healthcare Provider Details

I. General information

NPI: 1881531275
Provider Name (Legal Business Name): OSCAR LOPEZ RODRIGUEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 NW 192ND ST
MIAMI GARDENS FL
33055-2123
US

IV. Provider business mailing address

4370 NW 192ND ST
MIAMI GARDENS FL
33055-2123
US

V. Phone/Fax

Practice location:
  • Phone: 786-384-2762
  • Fax:
Mailing address:
  • Phone: 786-384-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-469
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3044
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3044
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: