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General NPI Number Information
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NPI Number | 1861923880
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Entity Type | Individual
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Provider Name | AMBAR R MARIN LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 7727 LAKE UNDERHILL ROAD
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City | ORLANDO
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State | FL
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Zip | 32822
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Country | US
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Telephone | 939-940-5924
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Fax |
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Provider Business Mailing Address
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Address Line | 10113 CANOPY TREE CT
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City | ORLANDO
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State | FL
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Zip | 32836-5942
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Country | US
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Telephone | 939-940-5924
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME144739
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License Number State | FL
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