Provider Demographics
NPI:1477857167
Name:LOPEZ, ALBERTO (RN)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8758 SW 12TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3365
Mailing Address - Country:US
Mailing Address - Phone:786-487-5082
Mailing Address - Fax:
Practice Address - Street 1:8758 SW 12TH ST APT 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3365
Practice Address - Country:US
Practice Address - Phone:786-487-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9256576163W00000X, 163WC1500X
FLARNP11006444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720171895OtherNPI - STATE OF FLORIDA, DBA: MIAMI-DADE COUNTY HEALTH DEPARTMENT