MEDICARE: RUTH ESTHER 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	363A00000X	Physician Assistant	002409-P.A.	PR
2	363A00000X	Physician Assistant	PACN107	FL

General Provider Information

NPI Number	:	1730999764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ESTHER LOPEZ

Provider Business Mailing Address
First Line	:	1118 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-392-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-392-1919
Fax Number	:

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

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/29/2026

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