Provider Demographics
NPI:1225489198
Name:LOPEZ, ESTER
Entity Type:Individual
Prefix:
First Name:ESTER
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 W FLAGLER ST
Mailing Address - Street 2:STE. 1A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2100
Mailing Address - Country:US
Mailing Address - Phone:786-615-2640
Mailing Address - Fax:
Practice Address - Street 1:8080 W FLAGLER ST
Practice Address - Street 2:STE. 1A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2100
Practice Address - Country:US
Practice Address - Phone:786-615-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC10677OtherAHCA LICENSE