Provider Demographics
NPI:1417143124
Name:LOPEZ, DOMINGO SILVANO (LPN)
Entity Type:Individual
Prefix:MR
First Name:DOMINGO
Middle Name:SILVANO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5206
Mailing Address - Country:US
Mailing Address - Phone:786-291-1298
Mailing Address - Fax:
Practice Address - Street 1:2 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5206
Practice Address - Country:US
Practice Address - Phone:786-291-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5189681164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse