Healthcare Provider Details

I. General information

NPI: 1134369846
Provider Name (Legal Business Name): CHRISTIAN SULLANO LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

V. Phone/Fax

Practice location:
  • Phone: 602-860-7778
  • Fax: 602-584-3985
Mailing address:
  • Phone: 602-860-7778
  • Fax: 602-584-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number49941
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: