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General NPI Number Information
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NPI Number | 1003454455
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Entity Type | Individual
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Provider Name | MISLAIDY LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1275 W 47TH PL STE 420
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City | HIALEAH
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State | FL
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Zip | 33012-3452
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Country | US
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Telephone | 786-353-3295
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Fax | 786-353-2249
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Provider Business Mailing Address
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Address Line | 714 E 18TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-4126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11005339
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License Number State | FL
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