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General NPI Number Information
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NPI Number | 1972644342
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Entity Type | Individual
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Provider Name | MANUEL LOPEZ PRIETO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 11474 QUAIL ROOST DR
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City | MIAMI
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State | FL
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Zip | 33157-6575
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Country | US
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Telephone | 305-793-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 26301 SW 133RD CT
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City | HOMESTEAD
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State | FL
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Zip | 33032-6892
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Country | US
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Telephone | 305-793-0959
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME79042
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License Number State | FL
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