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General NPI Number Information
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NPI Number | 1396272043
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Entity Type | Organization
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Legal Business Name | DR VIDAL N LOPEZ MD PA
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 2682 SW 87TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-2000
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Country | US
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Telephone | 305-480-5680
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Fax | 305-480-5702
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Provider Business Mailing Address
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Address Line | 2682 SW 87TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-2000
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Country | US
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Telephone | 305-480-5680
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Fax | 305-480-5702
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. VIDAL N LOPEZ
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Credential | MD
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Telephone | 305-480-5680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4844
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME14047
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License Number State | FL
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