# REYNALDO LOPEZ MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255771408
- **Authorized official:** REYNALDO LOPEZ MD (OWNER)
- **Authorized official phone:** (787) 240-4737

## Contact information

- **Practice address:** 15836 SW 61ST ST, MIAMI, FL 33193-3692
- **Practice address phone:** (787) 240-4737
- **Mailing address:** 15836 SW 61ST ST, MIAMI, FL 33193-3692
- **Mailing address phone:** (787) 240-4737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | FL | Yes |

## Other

- **Enumeration date:** 07/02/2013
- **Last updated:** 07/02/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0919CMEDICO | COMMERCIAL PLANS | FL |