Provider Demographics
NPI:1457014482
Name:LOPEZ PINA, SERGIO ANTONIO (APRN)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ANTONIO
Last Name:LOPEZ PINA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4870
Mailing Address - Country:US
Mailing Address - Phone:786-630-3690
Mailing Address - Fax:
Practice Address - Street 1:401 SW 42ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1938
Practice Address - Country:US
Practice Address - Phone:305-443-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty