Individual
MANUEL LOPEZ PRIETO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11474 QUAIL ROOST DR, MIAMI, FL 33157-6575
(305) 793-0959
Mailing address
26301 SW 133RD CT, HOMESTEAD, FL 33032-6892
(305) 793-0959
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME79042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257771200
—
FL
01
—
45913
BCBS PROV NUMBER
FL
01
—
ME79042
STATE LICENSE NUMBER
FL
Enumeration date
02/09/2007
Last updated
04/21/2011
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