Provider Demographics
NPI:1285321059
Name:LOPEZ, XIOMARA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:MICHELLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 EAST 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-579-5030
Mailing Address - Fax:718-579-4700
Practice Address - Street 1:234 EAST 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5030
Practice Address - Fax:718-579-4700
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program