Provider Demographics
NPI:1063476703
Name:LOPEZ, ARNALDO V (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNALDO
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 SW 1ST ST
Mailing Address - Street 2:200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2163
Mailing Address - Country:US
Mailing Address - Phone:305-541-3230
Mailing Address - Fax:305-541-1650
Practice Address - Street 1:1545 SW 1ST ST
Practice Address - Street 2:200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2163
Practice Address - Country:US
Practice Address - Phone:305-541-3230
Practice Address - Fax:305-541-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054864200Medicaid
FL1710160783OtherORGANIZATION NPI
FL71873UOtherMEDICARE PTAN
FL1710160783OtherORGANIZATION NPI