MEDICARE: MR. VINICIUS KLEE LOPES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	64270-20	WI

General Provider Information

NPI Number	:	1033420476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINICIUS KLEE LOPES M.D.

Provider Business Mailing Address
First Line	:	5207 SAN JOAQUIN PLZ # 5207
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5980
Country	:	US
Telephone Number	:	312-623-5834
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 SUPERIOR AVE STE 370
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2795
Country	:	US
Telephone Number	:	949-515-3590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	12/04/2024

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