Individual ProviderMayra LopezGeneral PracticeAllopathic & Osteopathic PhysiciansPractice Address4600 N Habana Ave Ste 32, Tampa, FL 33614-7123(813) 997-6042(813) 509-8083PECOS EnrollmentBased on the most recent information from CMS, provider Mayra Lopez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1558568816Provider TypeIndividualFull NameLopez, MayraTitleDr.CredentialM.D.GenderFemaleSole ProprietorYesEnumeration Date6/29/2007Last Updated4/8/2020Contact InformationPractice LocationPractice Address4600 N Habana Ave Ste 32, Tampa, FL 33614-7123Phone(813) 997-6042FaxUnlisted FaxMailing LocationMailing Address8904 W Hamilton Ave, Tampa, FL 33615-2726Phone(813) 509-8083FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208D00000XPrimaryDescriptionGeneral PracticeAllopathic & Osteopathic PhysiciansLicenseACN469FloridaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense16817Puerto RicoProvider IdentifiersIDDescriptionIssuerID009081300DescriptionMedicaidIssuerUnlistedFlorida