Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME0049266 | FL |
N | 2080A0000X | Adolescent Medicine | ME0049266 | FL |
NPI | 1104824077 |
---|---|
Provider Name | Dr. Rene Luis Lopez-Guerrero |
First Address | Miami, FL 33155-3009 |
Second Address | Miami, FL 33155-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046697200 | (05) | FL |
E21544 | (02) | FL |