MEDICARE: TANIA 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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992919385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA LOPEZ

Provider Business Mailing Address
First Line	:	1906 N A ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6002
Country	:	US
Telephone Number	:	561-541-1387
Fax Number	:	561-540-5491

Provider Business Practice Location Address
First Line	:	1906 N A ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6002
Country	:	US
Telephone Number	:	561-541-1387
Fax Number	:	561-540-5491

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/09/2007

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Directions to “ TANIA LOPEZ ” Practice Location

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