Provider Demographics
NPI:1942472949
Name:DR. RAPHAEL LOPEZ, LLC
Entity Type:Organization
Organization Name:DR. RAPHAEL LOPEZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-939-4268
Mailing Address - Street 1:1212 ROYCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4016
Mailing Address - Country:US
Mailing Address - Phone:321-939-4268
Mailing Address - Fax:
Practice Address - Street 1:131 WEBB DR
Practice Address - Street 2:SUITE C
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3921
Practice Address - Country:US
Practice Address - Phone:321-939-4268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty