Provider Demographics
NPI:1790269744
Name:FLORIDA RHEUMATOLOGY CARE
Entity Type:Organization
Organization Name:FLORIDA RHEUMATOLOGY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-725-1600
Mailing Address - Street 1:PO BOX 412077
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32941-2077
Mailing Address - Country:US
Mailing Address - Phone:321-725-1600
Mailing Address - Fax:321-725-1600
Practice Address - Street 1:7630 N WICKHAM RD STE 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8257
Practice Address - Country:US
Practice Address - Phone:321-725-1600
Practice Address - Fax:321-725-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-16
Last Update Date:2018-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01239200Medicaid