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General NPI Number Information
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NPI Number | 1043874464
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Entity Type | Individual
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Provider Name | AMANDA MAE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 336 AMBROSIA CT
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City | RIO RICO
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State | AZ
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Zip | 85648-2909
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Country | US
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Telephone | 520-721-1887
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Fax | 520-407-5398
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Provider Business Mailing Address
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Address Line | PO BOX 86537
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City | TUCSON
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State | AZ
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Zip | 85754-6537
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Country | US
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Telephone | 520-721-1887
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Fax | 520-372-7126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 8629369
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License Number State | AZ
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