Healthcare Provider Details

I. General information

NPI: 1255334215
Provider Name (Legal Business Name): WILLIAM J. LOPEZ II AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HILLVIEW STREET
SARASOTA FL
34239-3221
US

IV. Provider business mailing address

2800 HILLVIEW STREET
SARASOTA FL
34239-3221
US

V. Phone/Fax

Practice location:
  • Phone: 941-316-0406
  • Fax: 941-316-9317
Mailing address:
  • Phone: 941-316-0406
  • Fax: 941-316-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: