Organization
PORT ORANGE PEDIATRICS P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUBEN J LOPEZ MD (PRESIDENT)
(386) 322-5390
Entity
Organization
Contact information
Practice address
1720 DUNLAWTON AVE, SUITE 1, PORT ORANGE, FL 32127-2915
(386) 322-5390
Mailing address
1728 DUNLAWTON AVE STE 1, PORT ORANGE, FL 32127-2923
(386) 322-5390
(386) 322-5391
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0068668
FL
Other
Enumeration date
01/31/2008
Last updated
01/26/2022
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