Healthcare Provider Details

I. General information

NPI: 1346406709
Provider Name (Legal Business Name): MARIA C LOPEZ I RN.MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA GUADALUPE CORTEZ II NUN

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 N 16TH ST
PHOENIX AZ
85016-1802
US

IV. Provider business mailing address

6016 N 16TH ST
PHOENIX AZ
85016-1802
US

V. Phone/Fax

Practice location:
  • Phone: 520-302-7447
  • Fax: --
Mailing address:
  • Phone: 520-302-7447
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN073051
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: