MEDICARE: MRS. LUCERO LOPEZ OTR/L

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	171W00000X	Contractor	8644	FL

General Provider Information

NPI Number	:	1417129735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCERO LOPEZ OTR/L

Provider Business Mailing Address
First Line	:	15010 DUNBARTON PL
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1417
Country	:	US
Telephone Number	:	305-820-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	15010 DUNBARTON PL
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1417
Country	:	US
Telephone Number	:	305-820-5011
Fax Number	:

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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