Provider Demographics
NPI:1710947940
Name:LOPEZ-GUTIERREZ, JOSE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:LOPEZ-GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:LUIS
Other - Last Name:LOPEZ-GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3225 SW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2638
Mailing Address - Country:US
Mailing Address - Phone:305-910-6940
Mailing Address - Fax:
Practice Address - Street 1:3225 SW 124TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2638
Practice Address - Country:US
Practice Address - Phone:305-910-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38626OtherBS GROUP
FL274165200Medicaid
28726OtherBS INDIV
FL28726XMedicare PIN
FL274165200Medicaid
28726OtherBS INDIV
FLK0777Medicare ID - Type UnspecifiedGROUP