Provider Demographics
NPI:1467803411
Name:JORGE LOPEZ-CANINO, MD, PA
Entity Type:Organization
Organization Name:JORGE LOPEZ-CANINO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZCANINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-330-6692
Mailing Address - Street 1:16021 NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6644
Mailing Address - Country:US
Mailing Address - Phone:305-330-6692
Mailing Address - Fax:305-330-6686
Practice Address - Street 1:15495 EAGLE NEST LN STE 245
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-330-6692
Practice Address - Fax:305-330-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123509208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty