Provider Demographics
NPI:1275300014
Name:LOPEZ MESA, DILIERVYS R (APRN, RN)
Entity Type:Individual
Prefix:
First Name:DILIERVYS
Middle Name:R
Last Name:LOPEZ MESA
Suffix:
Gender:M
Credentials:APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4859
Mailing Address - Country:US
Mailing Address - Phone:786-828-0334
Mailing Address - Fax:
Practice Address - Street 1:8975 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-8901
Practice Address - Country:US
Practice Address - Phone:561-637-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty