Provider Demographics
NPI:1427225259
Name:LOPEZ, ROBERTO (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 BAHIA TERRADO CIR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2468
Mailing Address - Country:US
Mailing Address - Phone:239-898-4801
Mailing Address - Fax:
Practice Address - Street 1:10733 BAHIA TERRADO CIR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2468
Practice Address - Country:US
Practice Address - Phone:239-898-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA45169OtherLICENCE NUMBER