Provider Demographics
NPI:1457632085
Name:RENE L. LOPEZ-GUERRERO, M.D., P.A.
Entity Type:Organization
Organization Name:RENE L. LOPEZ-GUERRERO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ-GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-643-0133
Mailing Address - Street 1:3445 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4013
Mailing Address - Country:US
Mailing Address - Phone:305-643-0133
Mailing Address - Fax:305-643-1728
Practice Address - Street 1:3445 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4013
Practice Address - Country:US
Practice Address - Phone:305-643-0133
Practice Address - Fax:305-643-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49266208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046697200Medicaid