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General NPI Number Information
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NPI Number | 1700083086
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Entity Type | Organization
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Legal Business Name | LOPEZ MEDICAL PRACTICE LLC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 351 NW 42ND AVE SUITE 403
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City | MIAMI
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State | FL
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Zip | 33126-5683
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Country | US
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Telephone | 305-643-6447
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Fax | 305-541-5801
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Provider Business Mailing Address
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Address Line | PO BOX 651555
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City | MIAMI
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State | FL
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Zip | 33265-1555
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Country | US
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Telephone | 305-643-6447
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Fax | 305-541-5801
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLGA E LOPEZ
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Credential | M.D.
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Telephone | 305-643-6447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME89435
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License Number State | FL
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