Provider Demographics
NPI:1295354231
Name:LOPEZ CRAIG, MARIA CECILIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:LOPEZ CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CECILIA
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARIA C LOPEZ C
Mailing Address - Street 1:755 RINEHART RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4886
Mailing Address - Country:US
Mailing Address - Phone:407-320-8100
Mailing Address - Fax:407-320-8110
Practice Address - Street 1:755 RINEHART RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4886
Practice Address - Country:US
Practice Address - Phone:407-320-8100
Practice Address - Fax:407-320-8110
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME159570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME159570OtherMEDICAL LICENSE