Healthcare Provider Details

I. General information

NPI: 1508829581
Provider Name (Legal Business Name): ISIDRO A LOPEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 NW 20 STREET
MIAMI FL
33142
US

IV. Provider business mailing address

1495 NW 20 STREET
MIAMI FL
33142
US

V. Phone/Fax

Practice location:
  • Phone: 305-549-6000
  • Fax: 305-549-6006
Mailing address:
  • Phone: 305-549-6000
  • Fax: 305-549-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ISIDRO ANTONIO LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-549-6000