Provider Demographics
NPI:1285613935
Name:LOPEZ, ROBIN EVA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:EVA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 HAMILTON DR APT G
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2669
Mailing Address - Country:US
Mailing Address - Phone:305-252-4825
Mailing Address - Fax:305-252-4837
Practice Address - Street 1:19300 SW 376TH ST
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-6300
Practice Address - Country:US
Practice Address - Phone:305-246-4607
Practice Address - Fax:305-248-4715
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290674100Medicaid
FLE3654ZMedicare ID - Type Unspecified
FL290674100Medicaid