Provider Demographics
NPI:1578200846
Name:LOPEZ, CHRISTIAN ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ALEXIS
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 1:2958 N KITTERY PT
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5423
Mailing Address - Country:US
Mailing Address - Phone:732-867-6062
Mailing Address - Fax:
Practice Address - Street 1:821 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4623
Practice Address - Country:US
Practice Address - Phone:352-651-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16124-I390200000X
PR23478208D00000X
FLACN1604208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program