MEDICARE: GLORIA CAROLINA LOPEZ ALVARENGA MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	ME154198	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134781560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA CAROLINA LOPEZ ALVARENGA MD

Provider Business Mailing Address
First Line	:	PO BOX 919771
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-479-5202

Provider Business Practice Location Address
First Line	:	4300 KINGS HWY STE 210
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2922
Country	:	US
Telephone Number	:	239-344-2306
Fax Number	:	941-629-2365

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

Provider Enumeration Date	:	07/06/2019
Last Update Date	:	06/21/2022

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