Healthcare Provider Details

I. General information

NPI: 1831156470
Provider Name (Legal Business Name): ASTRID JANNETTE LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASTRID JANNETTE LOPEZ-CORREA MD

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAGNOLIA AVE SW
WINTER HAVEN FL
33880-2943
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax: 863-837-4441
Mailing address:
  • Phone: 866-234-8534
  • Fax: 863-837-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10007949
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13544
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: