Basic Information
| Provider Information | |||||||||
| NPI: | 1871901793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUPERCIO LOPEZ | ||||||||
| FirstName: | FLORENTINO | ||||||||
| MiddleName: | ALBERTO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 MEMORIAL MEDICAL PKWY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321175170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866721023 | ||||||||
| FaxNumber: | 3862632996 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 MEMORIAL MEDICAL PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321175170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866721023 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0001X | ME144467 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | ME144467 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.