Provider Demographics
NPI:1285829648
Name:LOPEZ, IVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 DEWEY ST
Mailing Address - Street 2:APT. #4
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6042
Mailing Address - Country:US
Mailing Address - Phone:954-695-8762
Mailing Address - Fax:
Practice Address - Street 1:7605 W 33RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-5003
Practice Address - Country:US
Practice Address - Phone:305-557-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist