Provider Demographics
NPI:1679603237
Name:LOPEZ, OLGA (PAC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30334 OLD DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033
Mailing Address - Country:US
Mailing Address - Phone:786-243-0149
Mailing Address - Fax:786-243-2612
Practice Address - Street 1:30334 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3215
Practice Address - Country:US
Practice Address - Phone:786-243-0149
Practice Address - Fax:786-243-2612
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical