Basic Information
Provider Information | |||||||||
NPI: | 1427243021 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOPEZ VALLE | ||||||||
FirstName: | MELITZA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOPEZ VALLE | ||||||||
OtherFirstName: | MELITZA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 121 S ORANGE AVE STE 940 | ||||||||
Address2: |   | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328013234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3213326947 | ||||||||
FaxNumber: | 3526062857 | ||||||||
Practice Location | |||||||||
Address1: | 1502 VILLAGE OAK LN | ||||||||
Address2: |   | ||||||||
City: | KISSIMMEE | ||||||||
State: | FL | ||||||||
PostalCode: | 347466558 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4075203588 | ||||||||
FaxNumber: | 4079786757 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/07/2007 | ||||||||
LastUpdateDate: | 03/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 18298 | PR | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 208D00000X | ME137458 | FL | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
No ID Information.