Individual
JORGE E LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
550 SW 69TH AVE, MIAMI, FL 33144-3636
(786) 388-6036
Mailing address
550 SW 69TH AVE, MIAMI, FL 33144-3636
(786) 388-6036
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
10478
FL
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
10478
FL
Other
Enumeration date
05/29/2007
Last updated
09/11/2025
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