Provider Demographics
NPI:1144885559
Name:LOPEZ, CYNTHIA IVY (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:IVY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 MAIN ST APT 2304
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2272
Mailing Address - Country:US
Mailing Address - Phone:281-961-0897
Mailing Address - Fax:
Practice Address - Street 1:2001 W 68TH ST STE 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1898
Practice Address - Country:US
Practice Address - Phone:305-364-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL155133208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program