Healthcare Provider Details

I. General information

NPI: 1134970163
Provider Name (Legal Business Name): LOPEZ PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CYPRESS WAY E STE 60A
NAPLES FL
34110-9275
US

IV. Provider business mailing address

4863 PALM COAST PKWY NW UNIT 2
PALM COAST FL
32137-3665
US

V. Phone/Fax

Practice location:
  • Phone: 239-832-9000
  • Fax: 239-206-1986
Mailing address:
  • Phone: 386-226-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MANUEL ENRIQUE LOPEZ DIEZ
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 386-222-7746