Provider Information for 1063887545
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LUIS LOPEZ MITCHELL
Sex: Male
NPI: 1063887545
Last Updated: 2016-08-23
Certification Date:
Certification Date:
Details
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NPI | 1063887545 | ||||||||
Enumeration Date | 2015-12-09 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 106 COLUMBIA ST ORLANDO, FL 32806-1006 United States Phone: 407-875-3700 | Fax:407-316-4504 | ||||||||
Primary Practice Address | 106 COLUMBIA ST ORLANDO, FL 32806-1006 United States Phone: 407-875-3700 | Fax:407-316-4504 | ||||||||
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