Provider Demographics
NPI:1134970163
Name:LOPEZ PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:LOPEZ PAIN MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:LOPEZ DIEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-222-7746
Mailing Address - Street 1:4863 PALM COAST PKWY NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3665
Mailing Address - Country:US
Mailing Address - Phone:386-226-7746
Mailing Address - Fax:
Practice Address - Street 1:90 CYPRESS WAY E STE 60A
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-832-9000
Practice Address - Fax:239-206-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty