Provider Demographics
NPI:1134477987
Name:ENRIQUE LOPEZ-MOSCOSO, M.D., P.A.
Entity Type:Organization
Organization Name:ENRIQUE LOPEZ-MOSCOSO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-MOSCOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-272-1618
Mailing Address - Street 1:601 N CONGRESS AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4703
Mailing Address - Country:US
Mailing Address - Phone:561-272-1618
Mailing Address - Fax:561-272-2800
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4703
Practice Address - Country:US
Practice Address - Phone:561-272-1618
Practice Address - Fax:561-272-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037569208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty