Provider Demographics
NPI:1134781560
Name:LOPEZ ALVARENGA, GLORIA CAROLINA (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:CAROLINA
Last Name:LOPEZ ALVARENGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:CAROLINA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-479-5202
Practice Address - Street 1:4300 KINGS HWY STE 210
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2922
Practice Address - Country:US
Practice Address - Phone:239-344-2306
Practice Address - Fax:941-629-2365
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME154198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program