Healthcare Provider Details

I. General information

NPI: 1730244765
Provider Name (Legal Business Name): ROSA LINDA LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSA L LOPEZ-COHEN MD

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-3248
  • Fax: 520-296-3249
Mailing address:
  • Phone: 520-296-3248
  • Fax: 520-296-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: