Provider Demographics
NPI:1659078780
Name:LOPEZ, DAVID LEONARDO (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONARDO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 E INDIGO ST STE 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5613
Mailing Address - Country:US
Mailing Address - Phone:305-255-3703
Mailing Address - Fax:305-255-8447
Practice Address - Street 1:9710 E INDIGO ST STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5613
Practice Address - Country:US
Practice Address - Phone:305-255-3703
Practice Address - Fax:305-255-8447
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily