Healthcare Provider Details

I. General information

NPI: 1629522461
Provider Name (Legal Business Name): LUCIA ARENZANA LOPEZ PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 353
PORTLAND OR
97213-2983
US

IV. Provider business mailing address

847 NE 19TH AVE STE 300
PORTLAND OR
97232-2686
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-4123
  • Fax: 503-297-0344
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA194270
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: