Provider Demographics
NPI:1366494957
Name:MALDONADO LOPEZ, HECTOR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:MANUEL
Last Name:MALDONADO LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HECTOR
Other - Middle Name:M
Other - Last Name:MALDONADO LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11501 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3313
Mailing Address - Country:US
Mailing Address - Phone:305-646-3716
Mailing Address - Fax:
Practice Address - Street 1:11501 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3313
Practice Address - Country:US
Practice Address - Phone:305-646-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01059Medicare UPIN