Healthcare Provider Details

I. General information

NPI: 1720288095
Provider Name (Legal Business Name): REGINA ROSA LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST SUITE 355
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

1 E ERIE ST STE 355
CHICAGO IL
60611-2772
US

V. Phone/Fax

Practice location:
  • Phone: 773-620-1026
  • Fax:
Mailing address:
  • Phone: 773-620-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036-118158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: