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General NPI Number Information
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NPI Number | 1316380819
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Entity Type | Individual
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Provider Name | MARIO LOPEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 2150 N BAYSHORE DR APT 1006
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City | MIAMI
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State | FL
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Zip | 33137-5457
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Country | US
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Telephone | 773-979-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 N BAYSHORE DR APT 1006
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City | MIAMI
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State | FL
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Zip | 33137-5457
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Country | US
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Telephone | 773-979-2525
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME129533
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME129533
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License Number State | FL
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