Provider Demographics
NPI:1104292846
Name:PINEDA LOPEZ, JUAN (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PINEDA LOPEZ
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 1:5564 E. GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5301
Mailing Address - Country:US
Mailing Address - Phone:321-235-6230
Mailing Address - Fax:321-235-6246
Practice Address - Street 1:5564 E GRANT STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5301
Practice Address - Country:US
Practice Address - Phone:321-235-6230
Practice Address - Fax:321-235-6246
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN683208D00000X
PR18959208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice