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General NPI Number Information
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NPI Number | 1114348653
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Entity Type | Individual
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Provider Name | JORGE LOPEZ NMD
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Gender | Male
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 2501 E SOUTHERN AVE STE 3
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City | TEMPE
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State | AZ
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Zip | 85282-7666
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Country | US
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Telephone | 602-492-7127
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Fax | 877-749-8607
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Provider Business Mailing Address
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Address Line | 2501 E SOUTHERN AVE STE 3
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City | TEMPE
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State | AZ
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Zip | 85282-7666
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Country | US
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Telephone | 602-770-9416
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Fax | 877-749-8607
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NP416
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 13-1414
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License Number State | AZ
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