Provider Demographics
NPI:1801479845
Name:LOPEZ, MARIA ELENA (ARNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5404
Mailing Address - Country:US
Mailing Address - Phone:786-286-8962
Mailing Address - Fax:786-899-0119
Practice Address - Street 1:4835 E 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1814
Practice Address - Country:US
Practice Address - Phone:786-899-0119
Practice Address - Fax:786-899-0440
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2020066603Medicaid