Provider Demographics
NPI:1033383211
Name:ELIZABETH LOPEZ MD PA
Entity Type:Organization
Organization Name:ELIZABETH LOPEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-493-5190
Mailing Address - Street 1:35C VENETIAN WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-8836
Mailing Address - Country:US
Mailing Address - Phone:786-493-5190
Mailing Address - Fax:
Practice Address - Street 1:3383 NW 7TH ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4140
Practice Address - Country:US
Practice Address - Phone:305-642-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty