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Individual

MR. EDDY JOSE LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4507 N ARMENIA AVE, TAMPA, FL 33603-2703
(813) 876-4100
(813) 876-4153
Mailing address
11804 ROSSMAYNE DR, RIVERVIEW, FL 33569-5657
(813) 390-1935

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9110687
FL

Other

Enumeration date
09/25/2017
Last updated
09/04/2020
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