=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043208002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABEL NATALI-LOPEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 08/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3415 LEE BLVD
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33971-1576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-738-7324
-----------------------------------------------------
Fax | 239-369-6419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 919771
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32891-9771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-278-3600
-----------------------------------------------------
Fax | 239-226-4650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME36788
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------