Provider Demographics
NPI:1174878078
Name:MARIA I LOPEZ MD PA
Entity type:Organization
Organization Name:MARIA I LOPEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-412-1967
Mailing Address - Street 1:8955 SW 87TH CT
Mailing Address - Street 2:STE 212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2230
Mailing Address - Country:US
Mailing Address - Phone:305-412-1967
Mailing Address - Fax:305-412-1861
Practice Address - Street 1:8955 SW 87TH CT
Practice Address - Street 2:STE 212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2230
Practice Address - Country:US
Practice Address - Phone:305-412-1967
Practice Address - Fax:305-412-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF66282Medicare UPIN
23338Medicare PIN