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General NPI Number Information
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NPI Number | 1184813149
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Entity Type | Individual
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Provider Name | JORGE LOPEZ-CANINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 15495 EAGLE NEST LN STE 245
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City | MIAMI LAKES
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State | FL
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Zip | 33014
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Country | US
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Telephone | 305-330-6692
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Fax | 305-330-6686
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Provider Business Mailing Address
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Address Line | PO BOX 653153
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City | MIAMI
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State | FL
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Zip | 33265-3153
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Country | US
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Telephone | 305-330-6692
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Fax | 305-330-6686
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME123509
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License Number State | FL
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