Provider Demographics
NPI:1851555759
Name:ORMENO LOPEZ, HEIDY CECILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDY
Middle Name:CECILIA
Last Name:ORMENO LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDY
Other - Middle Name:CECILIA ANA
Other - Last Name:ORMENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:1506 S FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3374
Practice Address - Country:US
Practice Address - Phone:321-257-0489
Practice Address - Fax:321-257-0491
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H2BOtherBCBS
FLFL611ZMedicare PIN