Provider Demographics
NPI:1770536575
Name:LOPEZ CINTRON, JOSE A (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LOPEZ CINTRON
Suffix:
Gender:M
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:PO BOX 741044
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1044
Mailing Address - Country:US
Mailing Address - Phone:386-774-9890
Mailing Address - Fax:386-774-9912
Practice Address - Street 1:963 TOWN CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8254
Practice Address - Country:US
Practice Address - Phone:386-774-9890
Practice Address - Fax:386-774-9912
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63977207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375402200Medicaid
FLF77215Medicare UPIN
FL23985BMedicare ID - Type Unspecified
FL375402200Medicaid