MEDICARE: ROBERT 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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1508657537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LOPEZ

Provider Business Mailing Address
First Line	:	1270 N WICKHAM RD.
Second Line	:	SUITE 16-212
City	:	MELBOURNE
State	:	FL
Zip	:	32935
Country	:	US
Telephone Number	:	717-203-4352
Fax Number	:

Provider Business Practice Location Address
First Line	:	2429 UTE DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2650
Country	:	US
Telephone Number	:	717-203-4352
Fax Number	:

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

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	05/17/2025

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