MEDICARE: CAMILO E LOPEZ P.A

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	363A00000X	Physician Assistant	9100817	FL

General Provider Information

NPI Number	:	1043253479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILO E LOPEZ P.A

Provider Business Mailing Address
First Line	:	10445 SW 128TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5540
Country	:	US
Telephone Number	:	305-232-8234
Fax Number	:	305-259-1931

Provider Business Practice Location Address
First Line	:	10445 SW 128TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5540
Country	:	US
Telephone Number	:	786-290-3211
Fax Number	:	305-259-1931

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/06/2016

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Directions to “ CAMILO E LOPEZ P.A” Practice Location

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