Provider Demographics
NPI:1538422688
Name:LOPEZ DE VICTORIA, MELBA DOLORES (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:DOLORES
Last Name:LOPEZ DE VICTORIA
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:1707 SIENNA DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-9030
Mailing Address - Country:US
Mailing Address - Phone:321-286-6085
Mailing Address - Fax:
Practice Address - Street 1:1304 OAK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3111
Practice Address - Country:US
Practice Address - Phone:321-723-4723
Practice Address - Fax:321-727-1448
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9223165367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered