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General NPI Number Information
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NPI Number | 1346527470
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Entity Type | Organization
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Legal Business Name | M I LOPEZ MD, PA
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 305 MEMORIAL MEDICAL PKWY SUITE 303
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5168
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Country | US
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Telephone | 386-672-8101
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Fax | 386-672-8102
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Provider Business Mailing Address
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Address Line | 305 MEMORIAL MEDICAL PARKWAY SUITE 303
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-672-8101
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Fax | 386-672-8102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA I LOPEZ
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Credential | M.D.
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Telephone | 386-672-8101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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