Provider Demographics
NPI:1740969831
Name:ROBLES LOPEZ, LUIS ALBERTO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:ROBLES 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 1:1444 NW 14TH AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1688
Mailing Address - Country:US
Mailing Address - Phone:786-620-5892
Mailing Address - Fax:
Practice Address - Street 1:1095 NW 14TH TER FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1060
Practice Address - Country:US
Practice Address - Phone:305-243-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38409174400000X, 261QM2500X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty