MEDICARE: JOSE FRANCISCO LOPEZ ST/SA-C

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	246ZC0007X	Surgical Assistant	17-185	FL

General Provider Information

NPI Number	:	1700313335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE FRANCISCO LOPEZ ST/SA-C

Provider Business Mailing Address
First Line	:	4190 NW 163RD ST
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33054-6142
Country	:	US
Telephone Number	:	305-297-9505
Fax Number	:

Provider Business Practice Location Address
First Line	:	7408 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2502
Country	:	US
Telephone Number	:	561-433-5700
Fax Number	:

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

Provider Enumeration Date	:	05/14/2017
Last Update Date	:	05/14/2017

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