Provider Demographics
NPI:1588913586
Name:LOPEZ, JOSE RAMON (FMD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAMON
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:FMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 W FLAGLER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1586
Mailing Address - Country:US
Mailing Address - Phone:305-774-9570
Mailing Address - Fax:305-774-9573
Practice Address - Street 1:4343 W FLAGLER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1586
Practice Address - Country:US
Practice Address - Phone:305-774-9570
Practice Address - Fax:305-774-9573
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator