Healthcare Provider Details

I. General information

NPI: 1689594806
Provider Name (Legal Business Name): LILLIANA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

IV. Provider business mailing address

1120 S FAIRFIELD AVE
LOMBARD IL
60148-4018
US

V. Phone/Fax

Practice location:
  • Phone: 630-743-4500
  • Fax:
Mailing address:
  • Phone: 773-759-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: