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General NPI Number Information
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NPI Number | 1275581829
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Entity Type | Individual
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Provider Name | LIDYA MARGARITA LATABAN-LOPEZ MD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 20 CYPRESS POINT PKWY STE A
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City | PALM COAST
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State | FL
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Zip | 32164-7528
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Country | US
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Telephone | 386-586-7005
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Fax | 844-867-3940
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone | 305-500-2000
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 15204
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN911
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License Number State | FL
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