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General NPI Number Information
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NPI Number | 1861791295
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Entity Type | Organization
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Legal Business Name | VICENTE G LOPEZ MD PA
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 8300 W FLAGLER ST SUITE 210
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City | MIAMI
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State | FL
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Zip | 33144-6000
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Country | US
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Telephone | 786-546-4855
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Fax | 305-274-0692
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Provider Business Mailing Address
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Address Line | 8300 W FLAGLER ST SUITE 210
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City | MIAMI
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State | FL
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Zip | 33144-6000
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Country | US
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Telephone | 786-546-4855
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Fax | 305-274-0692
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICENTE G LOPEZ
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Credential | MD
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Telephone | 786-546-4855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME82612
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License Number State | FL
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