MEDICARE: CARLOS LOPEZ

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	ME159928	FL

General Provider Information

NPI Number	:	1427511328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS LOPEZ

Provider Business Mailing Address
First Line	:	30 PROSPECT AVE
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 S HIGHLANDS AVE FL 33870
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-5416
Country	:	US
Telephone Number	:	786-223-9095
Fax Number	:

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

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/17/2026

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Directions to “ CARLOS LOPEZ ” Practice Location

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