Provider Demographics
NPI:1669776159
Name:IGNACIO LOPEZ-MERINO, M.D., PA
Entity type:Organization
Organization Name:IGNACIO LOPEZ-MERINO, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-MERINO, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-791-4774
Mailing Address - Street 1:7050 NW 4TH ST
Mailing Address - Street 2:SUITE#304
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2247
Mailing Address - Country:US
Mailing Address - Phone:954-791-4774
Mailing Address - Fax:954-791-2405
Practice Address - Street 1:7050 NW 4TH ST
Practice Address - Street 2:SUITE#304
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2247
Practice Address - Country:US
Practice Address - Phone:954-791-4774
Practice Address - Fax:954-791-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00490782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1265466106OtherNPI TYPE 1
FL02810Medicare PIN
FLD60911Medicare UPIN