Provider Demographics
NPI:1649349697
Name:LOPEZ-BORGES, MARIBEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:LOPEZ-BORGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:590 MALABAR RD SE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3108
Practice Address - Country:US
Practice Address - Phone:321-343-6140
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14365173000000X
FLACN1428208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21382Medicare ID - Type Unspecified