Individual
MARIA I LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 MEMORIAL MEDICAL PKWY, SUITE 303, DAYTONA BEACH, FL 32117-5168
(386) 615-8909
(386) 615-8910
Mailing address
550 MEMORIAL CIRCLE, UNIT N, ORMOND BEACH, FL 32174
(386) 615-8909
(386) 615-8910
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME86776
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266162400
—
FL
01
—
ME86776
UNITED BENEFITS
FL
Enumeration date
03/24/2006
Last updated
02/21/2020
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