Healthcare Provider Details

I. General information

NPI: 1265158414
Provider Name (Legal Business Name): LIILIBETH LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

20540 LEEWARD LN
CUTLER BAY FL
33189-2416
US

V. Phone/Fax

Practice location:
  • Phone: 800-432-6837
  • Fax:
Mailing address:
  • Phone: 305-878-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: