Provider Demographics
NPI:1235624842
Name:LOPEZ, THALIA (MD)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 PONCE DE LEON BLVD STE 607
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2074
Mailing Address - Country:US
Mailing Address - Phone:786-803-8252
Mailing Address - Fax:786-899-0775
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 607
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2074
Practice Address - Country:US
Practice Address - Phone:786-803-8252
Practice Address - Fax:786-899-0775
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147756207RR0500X, 207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program