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General NPI Number Information
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NPI Number | 1467803411
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Entity Type | Organization
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Legal Business Name | JORGE LOPEZ-CANINO, MD, PA
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Dates
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Enumeration Date | 06/30/2016
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Last Update Date | 06/06/2020
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Provider Practice Location Address
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Address Line | 15495 EAGLE NEST LN STE 245
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City | MIAMI LAKES
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State | FL
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Zip | 33014
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Country | US
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Telephone | 305-330-6692
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Fax | 305-330-6686
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Provider Business Mailing Address
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Address Line | 16021 NW 79TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6644
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Country | US
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Telephone | 305-330-6692
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Fax | 305-330-6686
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANA LOPEZCANINO
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Credential |
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Telephone | 305-330-6692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME123509
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License Number State | FL
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