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General NPI Number Information
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NPI Number | 1699161133
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Entity Type | Individual
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Provider Name | JENNIFER R LOPEZ LOPEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 700 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4924
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Country | US
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Telephone | 407-520-3947
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Fax |
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Provider Business Mailing Address
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Address Line | 8133 TOPSAIL PL
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4581
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Country | US
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Telephone | 787-718-0300
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 146317
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 146317
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 146317
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License Number State | FL
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