Provider Demographics
NPI:1811715832
Name:SERVICE AL LOPEZ LLC
Entity type:Organization
Organization Name:SERVICE AL LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FONSECA LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-399-8295
Mailing Address - Street 1:900 W 49TH ST STE 560
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3442
Mailing Address - Country:US
Mailing Address - Phone:786-989-7813
Mailing Address - Fax:
Practice Address - Street 1:900 W 49TH ST STE 560
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3442
Practice Address - Country:US
Practice Address - Phone:786-989-7813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty