Provider Demographics
NPI:1063698413
Name:BERTO LOPEZ M.D., P.A.
Entity type:Organization
Organization Name:BERTO LOPEZ M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-616-3939
Mailing Address - Street 1:1501 PRESIDENTIAL WAY STE 21
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1852
Mailing Address - Country:US
Mailing Address - Phone:561-616-3939
Mailing Address - Fax:561-616-3934
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:SUITE 21
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1800
Practice Address - Country:US
Practice Address - Phone:561-616-3939
Practice Address - Fax:561-616-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50960Medicare UPIN
FLK5968Medicare PIN