Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2709562 | FL |
NPI | 1013084375 |
---|---|
Provider Name | Mrs. Magda Lopez Rosa |
First Address | Orlando, FL 32828-8476 |
Second Address | Orlando, FL 32817-4374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |