Healthcare Provider Details

I. General information

NPI: 1922441963
Provider Name (Legal Business Name): MATHEW J LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 N CENTRAL AVE STE 1600
PHOENIX AZ
85004-4633
US

IV. Provider business mailing address

1850 N CENTRAL AVE STE 1600
PHOENIX AZ
85004-4633
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-8900
  • Fax: 602-262-8890
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55426
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: