Healthcare Provider Details

I. General information

NPI: 1144885559
Provider Name (Legal Business Name): CYNTHIA IVY LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SE OSCEOLA ST
STUART FL
34994-2577
US

IV. Provider business mailing address

448 SE OSCEOLA ST
STUART FL
34994-2577
US

V. Phone/Fax

Practice location:
  • Phone: 772-276-7242
  • Fax: 772-237-3109
Mailing address:
  • Phone: 772-276-7242
  • Fax: 772-237-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME155133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: