Provider Demographics
NPI:1548073216
Name:DIAZ LOPEZ, ANDREA NATALIA (DC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NATALIA
Last Name:DIAZ LOPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FLORAL SPRINGS BLVD UNIT 5102
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6803
Mailing Address - Country:US
Mailing Address - Phone:787-616-2738
Mailing Address - Fax:
Practice Address - Street 1:3429 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2402
Practice Address - Country:US
Practice Address - Phone:352-681-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor