| Tamara Lopez Diaz, Md. Pa | |
|
12301 Se Us Highway 441 Ste C Belleview FL 34420 | |
| (352) 327-8106 | |
| Not Available |
| Full Name | Tamara Lopez Diaz, Md. Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 12301 Se Us Highway 441 Ste C, Belleview, Florida |
| Authorized Official Name and Position | Tamara Lopez Diaz (PRESIDENT) |
| Authorized Official Contact | 7862781337 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tamara Lopez Diaz, Md. Pa 12301 Se Us Highway 441 Ste C Belleview FL 34420-4578 Ph: (352) 327-8106 | Tamara Lopez Diaz, Md. Pa 12301 Se Us Highway 441 Ste C Belleview FL 34420 Ph: (352) 327-8106 |
| NPI Number | 1124579974 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 01/24/2019 |
| Medicare PECOS PAC ID | 1456699776 |
|---|---|
| Medicare Enrollment ID | O20190212002731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124579974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME127189 (Florida) | Primary |
| Provider Name | Tamara Lopez Diaz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023478880 PECOS PAC ID: 8628353018 Enrollment ID: I20170327002813 |
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