Healthcare Provider Details

I. General information

NPI: 1427269414
Provider Name (Legal Business Name): PEDRO J LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST CASE MANAGEMENT
MIAMI FL
33142-5557
US

IV. Provider business mailing address

8889 FONTAINEBLEAU BLVD APARTMENT 101
MIAMI FL
33172-6408
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7444
  • Fax: 305-634-1303
Mailing address:
  • Phone: 305-221-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: