Provider Demographics
NPI:1588270748
Name:CARLO LOPEZ, YAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:YAMIL
Middle Name:
Last Name:CARLO LOPEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:YAMIL
Other - Middle Name:ALBERTO
Other - Last Name:CARLO LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:941 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3838
Practice Address - Country:US
Practice Address - Phone:352-326-4031
Practice Address - Fax:352-360-0257
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21990208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice