Provider Demographics
NPI:1851621536
Name:LOPEZ, VICTOR (ARNP)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:KLINGSHIRN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:78755 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1324
Mailing Address - Country:US
Mailing Address - Phone:760-507-5771
Mailing Address - Fax:
Practice Address - Street 1:1900 PURDY AVE APT 1011
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-1445
Practice Address - Country:US
Practice Address - Phone:760-507-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005933363LF0000X
FLARNP9221773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004180600Medicaid