Individual
DR. JUAN PABLO LOPEZ GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34490 CORTEZ BLVD, RIDGE MANOR, FL 33523-8908
(352) 583-4520
Mailing address
34490 CORTEZ BLVD, RIDGE MANOR, FL 33523-8908
(352) 583-4520
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
16911
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16911
MEDICINE LICENSE
PR
Enumeration date
11/28/2007
Last updated
05/22/2020
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