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General NPI Number Information
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NPI Number | 1417240433
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Entity Type | Individual
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Provider Name | MARIELA LOPEZ SADRAMELI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 4747 BELLAIRE BLVD STE 375
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City | BELLAIRE
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State | TX
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Zip | 77401-4600
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Country | US
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Telephone | 832-345-6352
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Fax |
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Provider Business Mailing Address
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Address Line | 14422 SHORESIDE WAY SUITE 110 BOX 112
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City | WINTER GARDEN
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State | FL
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Zip | 34787
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Country | US
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Telephone | 832-345-6352
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | R1408
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License Number State | TX
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