Provider Demographics
NPI:1003213315
Name:LOPEZ, PAUL (L AC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE 8 TER B2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK FL
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-400-8524
Mailing Address - Fax:
Practice Address - Street 1:3365 BURNS RD STE 202
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4303
Practice Address - Country:US
Practice Address - Phone:954-422-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist