Healthcare Provider Details

I. General information

NPI: 1124081823
Provider Name (Legal Business Name): LUZ ANGELA LOPEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUZ ANGELA CALDERON MD

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 E BASELINE RD STE 103
MESA AZ
85204-7290
US

IV. Provider business mailing address

3130 E BASELINE RD STE 103
MESA AZ
85204-7290
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-7618
  • Fax: 480-900-8884
Mailing address:
  • Phone: 480-539-7618
  • Fax: 480-539-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33381
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33381
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: