Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 11862 | FL |
NPI | 1356890545 |
---|---|
Provider Name | Dr. Jose Roberto Lopez Feliciano |
First Address | Doral, FL 33166-5457 |
Second Address | Doral, FL 33166-5457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2016 |
Last Update Date | 09/10/2016 |