Provider Demographics
NPI:1114370350
Name:LOPEZ, MARCOS ANTONIO (ARNP)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:ANTONIO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 NW 27TH AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2173
Mailing Address - Country:US
Mailing Address - Phone:305-635-7710
Mailing Address - Fax:786-621-7816
Practice Address - Street 1:1490 NW 27TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2173
Practice Address - Country:US
Practice Address - Phone:305-635-7710
Practice Address - Fax:786-621-7816
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283150363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021904100Medicaid