Individual
DR. ILEANA LOPEZ PLAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 WASHINGTON ST #826, BOSTON, MA 02111
(617) 636-5842
(617) 636-3175
Mailing address
750 WASHINGTON ST #826, BOSTON, MA 02111
(617) 636-5842
(617) 636-3175
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
221290
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2075431
—
MA
01
—
A37261
MEDICARE LO
MA
Enumeration date
11/20/2005
Last updated
07/31/2007
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