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General NPI Number Information
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NPI Number | 1154453397
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Entity Type | Individual
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Provider Name | FRANK ANTOLIN LOPEZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1992 MIZELL AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-4117
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Country | US
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Telephone | 407-644-4844
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Fax | 407-644-6101
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Provider Business Mailing Address
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Address Line | 121 S PHELPS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-5200
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Country | US
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Telephone | 407-678-1822
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Fax | 407-644-6101
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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 | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | ME54457
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License Number State | FL
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