Healthcare Provider Details

I. General information

NPI: 1447161807
Provider Name (Legal Business Name): MRS. TAMMY MAE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WILMOT RD
TUCSON AZ
85711-2678
US

IV. Provider business mailing address

11978 E CHAMROD DR
VAIL AZ
85641-1379
US

V. Phone/Fax

Practice location:
  • Phone: 520-873-3000
  • Fax:
Mailing address:
  • Phone: 520-405-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number201471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: