Healthcare Provider Details

I. General information

NPI: 1932683919
Provider Name (Legal Business Name): GEMMA JUSTICE LOPEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEMMA LINDSAY JUSTICE

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36453 N GANTZEL RD STE 101
SAN TAN VALLEY AZ
85140-7340
US

IV. Provider business mailing address

4881 E GRANT RD STE 101
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 480-636-1225
  • Fax: 480-636-8890
Mailing address:
  • Phone: 520-829-6776
  • Fax: 520-829-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number7208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: