Healthcare Provider Details

I. General information

NPI: 1649349697
Provider Name (Legal Business Name): MARIBEL LOPEZ-BORGES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARIBEL LOPEZ I

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MALABAR RD SE STE 1
PALM BAY FL
32907-3108
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 321-343-6140
  • Fax: 844-388-6186
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number14365
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: