Healthcare Provider Details

I. General information

NPI: 1275398018
Provider Name (Legal Business Name): PEDRO JOSE LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ADELBERT RD
CLEVELAND OH
44106-2624
US

IV. Provider business mailing address

15801 PARKLAND DR
CLEVELAND OH
44120-2531
US

V. Phone/Fax

Practice location:
  • Phone: 216-884-8840
  • Fax:
Mailing address:
  • Phone: 216-884-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberAPP00767228
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: