Individual
DR. MANUEL ENRIQUE LOPEZ DIEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4863 PALM COAST PKWY NW, PALM COAST, FL 32137-3666
(386) 222-7746
(904) 212-1351
Mailing address
155 BENT TRL, PONTE VEDRA, FL 32081-0846
(904) 707-5498
(904) 212-1351
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
15704
PR
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
4301087534
MI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
ME 107153
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008263500
—
FL
Enumeration date
06/29/2009
Last updated
12/28/2021
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