Healthcare Provider Details

I. General information

NPI: 1538141809
Provider Name (Legal Business Name): ELDA LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10661 N KENDALL DR STE 227
MIAMI FL
33176-1556
US

IV. Provider business mailing address

10661 N KENDALL DR STE 227
MIAMI FL
33176-1556
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-8000
  • Fax: 305-598-8019
Mailing address:
  • Phone: 305-598-8000
  • Fax: 305-598-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME86541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: