Provider Demographics
NPI:1861791295
Name:VICENTE G LOPEZ MD PA
Entity type:Organization
Organization Name:VICENTE G LOPEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-546-4855
Mailing Address - Street 1:8300 W FLAGLER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-6000
Mailing Address - Country:US
Mailing Address - Phone:786-546-4855
Mailing Address - Fax:305-274-0692
Practice Address - Street 1:8300 W FLAGLER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6000
Practice Address - Country:US
Practice Address - Phone:786-546-4855
Practice Address - Fax:305-274-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82612261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4169AMedicare PIN