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General NPI Number Information
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NPI Number | 1558660167
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Entity Type | Organization
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Legal Business Name | VICTOR LOPEZ DE MENDOZA, MD PLLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 1321 NW 14TH ST STE 603
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City | MIAMI
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State | FL
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Zip | 33125-1673
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Country | US
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Telephone | 305-547-1444
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Fax | 305-547-6787
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Provider Business Mailing Address
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Address Line | PO BOX 651472
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City | MIAMI
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State | FL
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Zip | 33265-1472
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Country | US
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Telephone | 305-480-6864
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTOR S LOPEZ DE MENDOZA
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Credential | MD
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Telephone | 305-448-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME105859
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License Number State | FL
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