Healthcare Provider Details

I. General information

NPI: 1205730553
Provider Name (Legal Business Name): STEPHANIE LOPEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 N POPLAR CT
CHANDLER AZ
85226-6801
US

IV. Provider business mailing address

678 N POPLAR CT
CHANDLER AZ
85226-6801
US

V. Phone/Fax

Practice location:
  • Phone: 480-267-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-22572
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: