Basic Information
| Provider Information | |||||||||
| NPI: | 1871032466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOPEZ PAIN MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4863 PALM COAST PKWY NW UNIT 2 | ||||||||
| Address2: | |||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321373665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103325303 | ||||||||
| FaxNumber: | 9042121351 | ||||||||
| Practice Location | |||||||||
| Address1: | 4863 PALM COAST PKWY NW UNIT 2&3 | ||||||||
| Address2: | |||||||||
| City: | PALM COAST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321373666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862227746 | ||||||||
| FaxNumber: | 9042121351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9047075498 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | ME107153 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.