Healthcare Provider Details

I. General information

NPI: 1255858072
Provider Name (Legal Business Name): ORCHID M LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ORCHID LEE MOLINA RN

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N CENTRAL AVE
PHOENIX AZ
85012-1817
US

IV. Provider business mailing address

5560 W MEGAN ST
CHANDLER AZ
85226-6810
US

V. Phone/Fax

Practice location:
  • Phone: 602-764-1025
  • Fax:
Mailing address:
  • Phone: 602-377-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN049077
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: