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General NPI Number Information
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NPI Number | 1053039271
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Entity Type | Individual
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Provider Name | CARSON LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1705 S SAN FRANCISCO ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86011-9206
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Country | US
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Telephone | 817-879-3923
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 N GEMINI DR APT 22
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1609
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATR-100214
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License Number State | AZ
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