Provider Demographics
NPI:1477001204
Name:ELDA M LOPEZ LLC
Entity Type:Organization
Organization Name:ELDA M LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-8000
Mailing Address - Street 1:10661 N KENDALL DR STE 227
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1556
Mailing Address - Country:US
Mailing Address - Phone:305-598-8000
Mailing Address - Fax:305-598-8019
Practice Address - Street 1:10661 N KENDALL DR STE 227
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1556
Practice Address - Country:US
Practice Address - Phone:305-598-8000
Practice Address - Fax:305-598-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME865412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty