MEDICARE: REYNALDO LOPEZ 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	207R00000X	Internal Medicine Physician	18208	PR
2	207R00000X	Internal Medicine Physician	ME111725	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	:	1215264536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO LOPEZ M.D

Provider Business Mailing Address
First Line	:	19161 SENECA AVE
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33332-2436
Country	:	US
Telephone Number	:	786-501-3757
Fax Number	:	954-400-3353

Provider Business Practice Location Address
First Line	:	4855 NW 183RD ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	786-501-3757
Fax Number	:

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

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	07/06/2021

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Directions to “ REYNALDO LOPEZ M.D” Practice Location

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