MEDICARE: MR. MIGUEL ERNESTO LOPEZ FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	308950	AZ
2	163WE0003X	Emergency Registered Nurse	RN154332	AZ

General Provider Information

NPI Number	:	1982445383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL ERNESTO LOPEZ FNP-C

Provider Business Mailing Address
First Line	:	3433 W SIERRA VISTA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1446
Country	:	US
Telephone Number	:	520-548-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 W SIERRA VISTA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-1446
Country	:	US
Telephone Number	:	520-548-8050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/14/2024

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