Healthcare Provider Details

I. General information

NPI: 1124222047
Provider Name (Legal Business Name): JOSIE LOPEZ CHW COM HEALTH WORKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSIE CAMPOS

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W COURT ST
PASCO WA
99301
US

IV. Provider business mailing address

PO BOX 1323
PASCO WA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-2204
  • Fax:
Mailing address:
  • Phone: 509-547-2204
  • Fax: 509-542-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: