Provider Demographics
NPI:1487062451
Name:EVELYN LOPEZ-BRIGNONI MD PA
Entity type:Organization
Organization Name:EVELYN LOPEZ-BRIGNONI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ BRIGNONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-670-1411
Mailing Address - Street 1:299 ALHAMBRA CIR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5106
Mailing Address - Country:US
Mailing Address - Phone:305-670-1411
Mailing Address - Fax:305-670-2811
Practice Address - Street 1:299 ALHAMBRA CIR
Practice Address - Street 2:SUITE 218
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5106
Practice Address - Country:US
Practice Address - Phone:305-670-1411
Practice Address - Fax:305-670-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00544582084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008280OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL008280OtherBLUE CROSS BLUE SHIELD OF FLORIDA