Healthcare Provider Details

I. General information

NPI: 1962324400
Provider Name (Legal Business Name): LOPEZ WELLNESS & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD STE 2
PHOENIX AZ
85053-2748
US

IV. Provider business mailing address

4025 W BELL RD STE 2
PHOENIX AZ
85053-2748
US

V. Phone/Fax

Practice location:
  • Phone: 602-999-5955
  • Fax:
Mailing address:
  • Phone: 602-999-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL LOPEZ
Title or Position: CEO
Credential: LPC-S
Phone: 602-488-1172