Healthcare Provider Details

I. General information

NPI: 1255890083
Provider Name (Legal Business Name): ALEJANDRO LOPEZ COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 VETERANS PARK DR STE 110
NAPLES FL
34109-0493
US

IV. Provider business mailing address

PO BOX 26067
SALT LAKE CITY UT
84126-0067
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0470
  • Fax: 239-624-0471
Mailing address:
  • Phone: 239-624-0470
  • Fax: 239-624-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME156298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: