Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME121337 | FL |
N | 207Q00000X | Family Doctor | MT200219 | PA |
NPI | 1003104027 |
---|---|
Provider Name | Lucy Rocio Gallegos Lopez |
First Address | Miami, FL 33179-5342 |
Second Address | Doral, FL 33178-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 18/09/2014 |