Provider Demographics
NPI:1265462675
Name:LOPEZ, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VICTORIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9595 N KENDALL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1979
Mailing Address - Country:US
Mailing Address - Phone:305-279-8222
Mailing Address - Fax:305-279-4096
Practice Address - Street 1:9595 N KENDALL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1979
Practice Address - Country:US
Practice Address - Phone:305-279-8222
Practice Address - Fax:305-279-4096
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70427207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF85619Medicare UPIN
FLK5219Medicare ID - Type Unspecified