Individual
JOSE CARLOS LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
654 NE 9TH PL, HOMESTEAD, FL 33030-4934
(305) 248-3488
(305) 248-6558
Mailing address
13168 SW 188TH ST, MIAMI, FL 33177-3002
(305) 609-7649
(305) 248-6558
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME55324
FL
2084P0800X
Psychiatry Physician
Primary
ME55324
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015064400
—
FL
01
—
ME55324
FLORIDA HEALTH DEPARTMENT
—
Enumeration date
02/15/2007
Last updated
09/15/2021
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