Provider Demographics
NPI:1538139936
Name:LOPEZ, MARIA O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:O
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 FOREST HILL BLVD RM 268
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6142
Mailing Address - Country:US
Mailing Address - Phone:561-753-7571
Mailing Address - Fax:561-753-7266
Practice Address - Street 1:10111 FOREST HILL BLVD RM 268
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-753-7571
Practice Address - Fax:561-753-7266
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62293207R00000X
FLME0062293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259541900Medicaid
FL26543Medicare ID - Type Unspecified
FLF96803Medicare UPIN