Provider Demographics
NPI:1558313627
Name:LOPEZ-LUCIANO, LUISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:M
Last Name:LOPEZ-LUCIANO
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 1:925 NE 30TH TER
Mailing Address - Street 2:SUITE 316
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7613
Mailing Address - Country:US
Mailing Address - Phone:305-245-8787
Mailing Address - Fax:305-245-8778
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:SUITE 316
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-245-8787
Practice Address - Fax:305-245-8778
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270089100Medicaid
FLH32732Medicare UPIN
FLU1142Medicare ID - Type Unspecified