Provider Demographics
NPI:1982624466
Name:MARIA O. LOPEZ, M.D., LLC
Entity Type:Organization
Organization Name:MARIA O. LOPEZ, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-753-7571
Mailing Address - Street 1:10111 FOREST HILL BLVD RM 268
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6142
Mailing Address - Country:US
Mailing Address - Phone:561-753-7571
Mailing Address - Fax:561-753-7266
Practice Address - Street 1:10111 FOREST HILL BLVD RM 268
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-753-7571
Practice Address - Fax:561-753-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259541900Medicaid
FL259541900Medicaid
FL26543Medicare ID - Type Unspecified