Individual
BRYAN R LOPEZ ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
708 DEL PRADO BLVD S STE 9, CAPE CORAL, FL 33990-2633
(239) 424-2440
(239) 343-4258
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-2440
(239) 343-4258
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9118453
FL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121313000
—
FL
Enumeration date
01/01/2024
Last updated
03/06/2024
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