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General NPI Number Information
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NPI Number | 1023348604
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Entity Type | Organization
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Legal Business Name | LUIS R. LOPEZ M.D., LTD
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 3330 N 2ND ST STE 400
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City | PHOENIX
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State | AZ
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Zip | 85012-2371
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Country | US
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Telephone | 602-631-4090
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Fax | 602-631-4093
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Provider Business Mailing Address
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Address Line | 521 W THOMAS RD FL 1
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City | PHOENIX
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State | AZ
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Zip | 85013-4226
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Country | US
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Telephone | 602-631-4090
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Fax | 602-631-4093
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MR. LUIS RAUL LOPEZ JR.
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Credential |
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Telephone | 602-631-9873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 12246
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License Number State | AZ
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