Healthcare Provider Details

I. General information

NPI: 1548987225
Provider Name (Legal Business Name): ANA KARINA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14331 SW 120TH ST STE 208
MIAMI FL
33186-7297
US

IV. Provider business mailing address

801 SW 94TH AVE
MIAMI FL
33174-3039
US

V. Phone/Fax

Practice location:
  • Phone: 964-630-5408
  • Fax:
Mailing address:
  • Phone: 786-620-3582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberBACB649437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: