Individual
VIRGILIO DIZON LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5201 RAYMOND ST, ORLANDO, FL 32803-8208
(407) 621-2632
Mailing address
4095 WATERVIEW LOOP, WINTER PARK, FL 32792-7602
(407) 657-6523
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME80547
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A332200
—
CA
Enumeration date
03/15/2007
Last updated
09/13/2010
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