Healthcare Provider Details

I. General information

NPI: 1447302567
Provider Name (Legal Business Name): IRENE LOPEZ-ALBELO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17892 SW 152ND CT
MIAMI FL
33187
US

IV. Provider business mailing address

17892 SW 152ND CT
MIAMI FL
33187-7764
US

V. Phone/Fax

Practice location:
  • Phone: 305-491-4955
  • Fax: 786-592-2774
Mailing address:
  • Phone: 305-491-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME86022
License Number StateFL

VIII. Authorized Official

Name: IRENE LOPEZ-ALBELO
Title or Position: OWNER
Credential: MD
Phone: 305-491-4955