Provider Demographics
NPI:1831142793
Name:JOSE A LOPEZ-CINTRON MD LLC
Entity Type:Organization
Organization Name:JOSE A LOPEZ-CINTRON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ-CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-774-9890
Mailing Address - Street 1:PO BOX 741044
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1044
Mailing Address - Country:US
Mailing Address - Phone:386-774-9890
Mailing Address - Fax:386-774-9912
Practice Address - Street 1:963 TOWN CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8254
Practice Address - Country:US
Practice Address - Phone:386-774-9890
Practice Address - Fax:386-774-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63977207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty