Healthcare Provider Details

I. General information

NPI: 1194381798
Provider Name (Legal Business Name): RAYMOND LOPEZ DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD STE 940
MIAMI BEACH FL
33140-4560
US

IV. Provider business mailing address

4308 ALTON RD STE 940
MIAMI BEACH FL
33140-4560
US

V. Phone/Fax

Practice location:
  • Phone: 305-604-3216
  • Fax: 305-604-3217
Mailing address:
  • Phone: 305-604-3216
  • Fax: 305-604-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND LOPEZ
Title or Position: OWNER
Credential: DPM
Phone: 305-604-3216