Individual
JOSE LUIS LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6459 SW COUNTY ROAD 18 UNIT 4, FORT WHITE, FL 32038-3464
(352) 474-9788
Mailing address
504 SW BUCCHI GLN, FORT WHITE, FL 32038-2936
(352) 474-9788
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474115030
—
FL
Enumeration date
01/23/2019
Last updated
01/23/2019
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