Provider Demographics
NPI:1427269414
Name:LOPEZ, PEDRO J
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8889 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APARTMENT 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6408
Mailing Address - Country:US
Mailing Address - Phone:305-221-3542
Mailing Address - Fax:
Practice Address - Street 1:1469 NW 36TH ST
Practice Address - Street 2:CASE MANAGEMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5557
Practice Address - Country:US
Practice Address - Phone:305-635-7444
Practice Address - Fax:305-634-1303
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management