1508354861 NPI number — DIEGO JOSE LOPES DE LIMA MD

Table of content: DIEGO JOSE LOPES DE LIMA MD (NPI 1508354861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508354861 NPI number — DIEGO JOSE LOPES DE LIMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPES DE LIMA
Provider First Name:
DIEGO JOSE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1508354861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10131 FOREST HILL BLVD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-6109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-798-6600
Provider Business Mailing Address Fax Number:
561-753-3328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 MILITARY TRL STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-798-6600
Provider Business Practice Location Address Fax Number:
561-753-3328
Provider Enumeration Date:
04/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  ME146444 , 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)

  • Identifier: 107422800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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