Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 105859 | FL |
NPI | 1073667770 |
---|---|
Provider Name | Victor Sergio Lopez De Mendoza |
First Address | Miami, FL 33133-4214 |
Second Address | Miami, FL 33133-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105859 | ME (01) | FL |
FL1754387 | DEA (01) | FL |