Provider Demographics
NPI:1558392134
Name:LOPEZ, REMBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:REMBERTO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 SW PINE ISLAND RD STE 306
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1943
Mailing Address - Country:US
Mailing Address - Phone:239-984-5610
Mailing Address - Fax:239-984-5563
Practice Address - Street 1:949 CHIQUITA BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2143
Practice Address - Country:US
Practice Address - Phone:239-984-5610
Practice Address - Fax:239-984-5563
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1206207Q00000X
FLPA9102608363AM0700X
TXBP10040024390200000X
FLME120649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program