FABIAN A LOPEZ MD PA
Osteopathic Medicine at Alton Rd, Miami, FL

License number
Florida 79561
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: FABIAN A LOPEZ MD
Title: PRESIDENT
Phone: (305) 673-8570
Address
Address
4302 Alton Rd STE 430, Miami, FL 33140
National Provider ID: 1861675886
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FABIAN A. LOPEZ M.D. PA

Miami, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Jun 15, 2006
Inactive since:
Dec 4, 2009
Addresses:
4308 Alton Rd STE 740, Miami Beach, FL 33140 (Physical)
Miami Beach, FL 33119 (Mailing)
PO Box 190367, Miami, FL 33119
State ID:
P06000081904
Business type:
Florida Profit Corporation
Vice Presidents:
Fabian Amd Lopez (President), 1900 Sunset Harbour Dr #1011, Miami Beach, FL 33139 (Physical),Walter A. Houck-Cruz Vice President, inactive
Agent:
Fabian Lopez,1900 Sunset Harbour Dr, Miami Beach, FL 33139 (Physical)
EIN:
205379636

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