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General NPI Number Information
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NPI Number | 1477001204
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Entity Type | Organization
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Legal Business Name | ELDA M LOPEZ LLC
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 10661 N KENDALL DR STE 227
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City | MIAMI
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State | FL
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Zip | 33176-1556
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Country | US
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Telephone | 305-598-8000
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Fax | 305-598-8019
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Provider Business Mailing Address
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Address Line | 10661 N KENDALL DR STE 227
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City | MIAMI
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State | FL
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Zip | 33176-1556
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Country | US
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Telephone | 305-598-8000
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Fax | 305-598-8019
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Authorized Official
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Title or Position | OWNER
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Name | ELDA M LOPEZ
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Credential | MD
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Telephone | 305-598-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME86541
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License Number State | FL
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