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General NPI Number Information
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NPI Number | 1255163143
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Entity Type | Individual
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Provider Name | YARISLEIDYS LUIS LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 11740 SW 80TH ST
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City | MIAMI
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State | FL
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Zip | 33183-3848
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Country | US
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Telephone | 786-235-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 8925 NW 33RD AVENUE RD
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City | MIAMI
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State | FL
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Zip | 33147-2809
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Country | US
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Telephone | 786-953-9808
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 11034500
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9521736
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License Number State | FL
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