Healthcare Provider Details

I. General information

NPI: 1932883774
Provider Name (Legal Business Name): PROSPERITY FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 PROSPERITY FARMS RD STE 215
PALM BEACH GARDENS FL
33410-3465
US

IV. Provider business mailing address

225 SONOMA ISLES CIR
JUPITER FL
33478-5494
US

V. Phone/Fax

Practice location:
  • Phone: 561-794-0456
  • Fax: 561-794-0457
Mailing address:
  • Phone: 786-597-3223
  • Fax: 561-794-0457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HECTOR NARANJO LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 786-597-3223