Provider Demographics
NPI:1841430774
Name:LOPEZ RAYMAT, JOSE A (ARNP,SAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:LOPEZ RAYMAT
Suffix:
Gender:M
Credentials:ARNP,SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 GRAND CANAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2150
Mailing Address - Country:US
Mailing Address - Phone:786-379-1204
Mailing Address - Fax:
Practice Address - Street 1:8000 GRAND CANAL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2150
Practice Address - Country:US
Practice Address - Phone:786-379-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO08194246ZC0007X
FLAPRN11030303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08194OtherAMERICAN BOARD OF SURGICAL ASSISTANTS