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General NPI Number Information
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NPI Number | 1629231980
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Entity Type | Individual
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Provider Name | LIDICE LOPEZ PA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 1400 NW 12TH AVE SUITE 104
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City | MIAMI
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State | FL
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Zip | 33136-1003
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Country | US
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Telephone | 305-545-6685
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Fax | 305-565-6687
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Provider Business Mailing Address
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Address Line | 261 W 32ND ST
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City | HIALEAH
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State | FL
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Zip | 33012-5317
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Country | US
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Telephone | 305-528-0447
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Fax | 305-466-3223
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104530
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License Number State | FL
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