Healthcare Provider Details

I. General information

NPI: 1184454340
Provider Name (Legal Business Name): ANAHI LOPEZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14557 W INDIAN SCHOOL RD
GOODYEAR AZ
85395-9243
US

IV. Provider business mailing address

14557 W INDIAN SCHOOL RD
GOODYEAR AZ
85395-9243
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-6908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: