Provider Demographics
NPI:1306060256
Name:LOPEZ-BRIGNONI, EVELYN (MD, PA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:LOPEZ-BRIGNONI
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 ALHAMBRA CIR STE 218
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5116
Mailing Address - Country:US
Mailing Address - Phone:305-670-1411
Mailing Address - Fax:305-670-2811
Practice Address - Street 1:299 ALHAMBRA CIR
Practice Address - Street 2:STE. 218
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-670-1411
Practice Address - Fax:305-670-2811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME544582084P0804X
FLME00544582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008392200Medicaid
FL08280ZOtherMEDICARE
FLE69003Medicare UPIN
FL08280ZOtherMEDICARE
FLE69003Medicare UPIN