Provider Demographics
NPI:1083094262
Name:CELESTINO LOPEZ OMD LLC
Entity Type:Organization
Organization Name:CELESTINO LOPEZ OMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:786-284-0117
Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:786-284-0117
Mailing Address - Fax:786-558-9320
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:SUITE 319
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:786-284-0117
Practice Address - Fax:786-558-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP355261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain