Provider Demographics
NPI:1740737048
Name:LOPEZ-VALLE, RICARDO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:LOPEZ-VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 VENETIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7163
Mailing Address - Country:US
Mailing Address - Phone:941-483-5730
Mailing Address - Fax:941-483-5740
Practice Address - Street 1:825 VENETIAN PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7163
Practice Address - Country:US
Practice Address - Phone:941-483-5730
Practice Address - Fax:941-483-5740
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME168476207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology