Individual
TANIA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7915 83RD AVE, SEBASTIAN, FL 32958-3282
(772) 589-0580
(877) 291-0858
Mailing address
7915 83RD AVE, SEBASTIAN, FL 32958-3282
(772) 589-0580
(877) 291-0858
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS12965
FL
207R00000X
Internal Medicine Physician
UO3569
FL
207RG0100X
Gastroenterology Physician
ML0512965
FL
207RG0100X
Gastroenterology Physician
Primary
OS12965
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0137977-00
—
FL
05
—
106666600
—
FL
Enumeration date
09/04/2013
Last updated
04/01/2025
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