Provider Demographics
NPI:1427243021
Name:LOPEZ VALLE, MELITZA
Entity type:Individual
Prefix:DR
First Name:MELITZA
Middle Name:
Last Name:LOPEZ VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MELITZA
Other - Middle Name:
Other - Last Name:LOPEZ VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:7714 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8422
Practice Address - Country:US
Practice Address - Phone:407-745-4581
Practice Address - Fax:407-745-4583
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18298208D00000X
FLME137458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24407Medicare PIN