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General NPI Number Information
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NPI Number | 1104504232
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO LOPEZ JR. RN
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Gender | Male
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 21610 SOUTHWOOD DR
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City | LUTZ
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State | FL
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Zip | 33549-4126
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Country | US
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Telephone | 813-294-5546
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Fax | 813-354-3408
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Provider Business Mailing Address
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Address Line | 6421 N FLORIDA AVE # D1789
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City | TAMPA
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State | FL
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Zip | 33604-6007
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Country | US
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Telephone | 813-294-5546
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Fax | 813-354-3408
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 224886
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License Number State | TN
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