Provider Demographics
NPI:1215742648
Name:LOPEZ, MARIA E (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 SW 88TH ST STE 295
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1546
Mailing Address - Country:US
Mailing Address - Phone:786-354-2973
Mailing Address - Fax:786-224-0907
Practice Address - Street 1:719 85TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1109
Practice Address - Country:US
Practice Address - Phone:786-354-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTTPA581208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice