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General NPI Number Information
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NPI Number | 1760958144
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Entity Type | Individual
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Provider Name | RAPHAEL JOSEPH LOPEZ ARNP FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 8201 W BROWARD BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-2701
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Country | US
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Telephone | 954-473-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 13847 NW 22ND CT
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City | SUNRISE
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State | FL
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Zip | 33323-5306
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Country | US
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Telephone | 954-604-5755
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9348684
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9348684
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License Number State | FL
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