Provider Demographics
NPI:1215344627
Name:LOPEZ, DIANA C (ARNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SILKS RUN UNIT 1265
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2570
Mailing Address - Country:US
Mailing Address - Phone:305-760-1431
Mailing Address - Fax:
Practice Address - Street 1:600 SILKS RUN UNIT 1265
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2570
Practice Address - Country:US
Practice Address - Phone:305-760-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner