Healthcare Provider Details

I. General information

NPI: 1023378429
Provider Name (Legal Business Name): KATHERINE LOPEZ SANKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LOPEZ

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 SE 32ND AVE STE 205
MILWAUKIE OR
97222-6594
US

IV. Provider business mailing address

16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
HAPPY VALLEY OR
97086-4257
US

V. Phone/Fax

Practice location:
  • Phone: 503-513-8950
  • Fax:
Mailing address:
  • Phone: 503-658-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD165666
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: