1700083086 NPI number — LOPEZ MEDICAL PRACTICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700083086 NPI number — LOPEZ MEDICAL PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOPEZ MEDICAL PRACTICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700083086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 651555
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33265-1555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-643-6447
Provider Business Mailing Address Fax Number:
305-541-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 NW 42ND AVE
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-643-6447
Provider Business Practice Location Address Fax Number:
305-541-5801
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-643-6447

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  ME89435 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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