Individual
OMAR BALBOA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
3661 S MIAMI AVE, SUITE 708, MIAMI, FL 33133-4236
(305) 858-9879
(305) 856-0199
Mailing address
3661 S MIAMI AVE, SUITE 708, MIAMI, FL 33133-4236
(305) 858-9879
(305) 856-0199
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
10176
FL
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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