Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 11005339 | FL |
NPI | 1003454455 |
---|---|
Provider Name | Mislaidy Lopez |
First Address | Hialeah, FL 33013-4126 |
Second Address | Hialeah, FL 33013-4126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 17/12/2019 |