Healthcare Provider Details

I. General information

NPI: 1356134142
Provider Name (Legal Business Name): DONNITA LOPEZ-PEREZ CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4818 WASHINGTON BLVD
SAINT LOUIS MO
63108-1829
US

IV. Provider business mailing address

4818 WASHINGTON BLVD
SAINT LOUIS MO
63108-1829
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-5408
  • Fax:
Mailing address:
  • Phone: 314-200-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberN25101506
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: