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General NPI Number Information
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NPI Number | 1457014482
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Entity Type | Individual
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Provider Name | SERGIO ANTONIO LOPEZ PINA APRN
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Gender | Male
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/17/2021
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Provider Practice Location Address
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Address Line | 401 SW 42ND AVE STE 200
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City | CORAL GABLES
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State | FL
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Zip | 33134-1938
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Country | US
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Telephone | 305-443-9943
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Fax |
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Provider Business Mailing Address
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Address Line | 2633 SW 154TH CT
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City | MIAMI
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State | FL
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Zip | 33185-4870
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Country | US
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Telephone | 786-630-3690
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11015872
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License Number State | FL
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