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General NPI Number Information
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NPI Number | 1205160355
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO DEL VALLE PC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 2929 N 75TH AVE SUITE 5
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City | PHOENIX
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State | AZ
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Zip | 85033-5400
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Country | US
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Telephone | 623-873-1200
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Fax | 623-873-1300
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Provider Business Mailing Address
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Address Line | 2929 N 75TH AVE SUITE 5
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City | PHOENIX
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State | AZ
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Zip | 85033-5400
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Country | US
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Telephone | 623-873-1200
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Fax | 623-873-1300
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Authorized Official
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Title or Position | OWNER
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Name | DR. ENRIQUE S LOPEZ
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Credential | MD
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Telephone | 623-873-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35764
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License Number State | AZ
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