Provider Demographics
NPI:1669745212
Name:LOPEZ, ELIO
Entity type:Individual
Prefix:MR
First Name:ELIO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4202
Mailing Address - Country:US
Mailing Address - Phone:813-325-5966
Mailing Address - Fax:813-442-5019
Practice Address - Street 1:3310 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4202
Practice Address - Country:US
Practice Address - Phone:813-325-5966
Practice Address - Fax:813-442-5019
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor