Healthcare Provider Details

I. General information

NPI: 1114370350
Provider Name (Legal Business Name): MARCOS ANTONIO LOPEZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/21/2022
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NW 27TH AVE STE 130
MIAMI FL
33125-2173
US

IV. Provider business mailing address

1490 NW 27TH AVE STE 130
MIAMI FL
33125-2173
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7710
  • Fax: 786-621-7816
Mailing address:
  • Phone: 305-635-7710
  • Fax: 786-621-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9283150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: