MEDICARE: DALMA 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1962750844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALMA LOPEZ

Provider Business Mailing Address
First Line	:	11206 PLACID LAKE CT
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-2921
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:	813-490-5495

Provider Business Practice Location Address
First Line	:	11206 PLACID LAKE CT
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-2921
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:	813-490-5495

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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Directions to “ DALMA LOPEZ ” Practice Location

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