Provider Demographics
NPI:1700313335
Name:LOPEZ, JOSE FRANCISCO (ST/SA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FRANCISCO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ST/SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 NW 163RD ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6142
Mailing Address - Country:US
Mailing Address - Phone:305-297-9505
Mailing Address - Fax:
Practice Address - Street 1:7408 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2502
Practice Address - Country:US
Practice Address - Phone:561-433-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-185246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant