Provider Demographics
NPI:1891083192
Name:ARAGON LOPEZ, MARTHA CATALINA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:CATALINA
Last Name:ARAGON LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BUDINGER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6005
Mailing Address - Country:US
Mailing Address - Phone:407-892-3387
Mailing Address - Fax:407-892-7297
Practice Address - Street 1:3286 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:407-499-4911
Practice Address - Fax:407-530-4765
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME120067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHV316ZMedicare PIN