Provider Demographics
NPI:1053363697
Name:DAVINA MEDICAL CARE, P.A.
Entity type:Organization
Organization Name:DAVINA MEDICAL CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ-LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-245-8787
Mailing Address - Street 1:151 NW 11TH ST
Mailing Address - Street 2:SUITE: E-304
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4360
Mailing Address - Country:US
Mailing Address - Phone:305-245-8787
Mailing Address - Fax:305-245-8778
Practice Address - Street 1:151 NW 11TH ST
Practice Address - Street 2:SUITE: E-304
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4360
Practice Address - Country:US
Practice Address - Phone:305-245-8787
Practice Address - Fax:305-245-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME84057OtherME #
FLBL7183368OtherDEA
FLBL7183368OtherDEA