Provider Demographics
NPI:1811137664
Name:LOPEZ, JUAN F (MA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 W 49TH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3148
Mailing Address - Country:US
Mailing Address - Phone:305-823-4008
Mailing Address - Fax:305-823-4009
Practice Address - Street 1:1490 W 49 PL
Practice Address - Street 2:SUITE 210
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-823-4008
Practice Address - Fax:305-823-4009
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 51137247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other