Provider Demographics
NPI:1205852993
Name:LOPEZ, MARIA RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:RAQUEL
Last Name:LOPEZ
Suffix:
Gender:F
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:PO BOX 160010
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-0001
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:SUITE209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:786-924-1311
Practice Address - Fax:786-924-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist