Healthcare Provider Details

I. General information

NPI: 1033029251
Provider Name (Legal Business Name): GL MEDICAL GROUP AN AZ PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2851 S AVENUE B # 8
YUMA AZ
85364-7726
US

IV. Provider business mailing address

340 W 32ND ST # 412
YUMA AZ
85364-8128
US

V. Phone/Fax

Practice location:
  • Phone: 928-510-2697
  • Fax:
Mailing address:
  • Phone: 928-510-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLENA LOPEZ
Title or Position: CEO
Credential: NP
Phone: 928-510-2697