Healthcare Provider Details

I. General information

NPI: 1457632085
Provider Name (Legal Business Name): RENE L. LOPEZ-GUERRERO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 NW 7TH ST
MIAMI FL
33125-4013
US

IV. Provider business mailing address

3445 NW 7TH ST
MIAMI FL
33125-4013
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-0133
  • Fax: 305-643-1728
Mailing address:
  • Phone: 305-643-0133
  • Fax: 305-643-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME49266
License Number StateFL

VIII. Authorized Official

Name: DR. RENE LUIS LOPEZ-GUERRERO
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 305-643-0133