Healthcare Provider Details

I. General information

NPI: 1467494518
Provider Name (Legal Business Name): LAWRENCE VINCENT LOPEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD SUITE 850
PHOENIX AZ
85013-4224
US

IV. Provider business mailing address

500 W THOMAS RD SUITE 850
PHOENIX AZ
85013-4224
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-2663
  • Fax:
Mailing address:
  • Phone: 602-406-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2954
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2954
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2954
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: