MEDICARE: DR. IVETTE LOPEZ PH.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	183500000X	Pharmacist	16525	FL

General Provider Information

NPI Number	:	1285829648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVETTE LOPEZ PH.D.

Provider Business Mailing Address
First Line	:	1849 DEWEY ST
Second Line	:	APT. #4
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6042
Country	:	US
Telephone Number	:	954-695-8762
Fax Number	:

Provider Business Practice Location Address
First Line	:	7605 W 33RD CT
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-5003
Country	:	US
Telephone Number	:	305-557-6395
Fax Number	:

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

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Directions to “ DR. IVETTE LOPEZ PH.D.” Practice Location

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