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General NPI Number Information
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NPI Number | 1326477134
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Entity Type | Individual
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Provider Name | JUAN JOSE LOPEZ RN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 6223 N 21ST DR
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City | PHOENIX
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State | AZ
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Zip | 85015-1902
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Country | US
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Telephone | 623-419-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 6223 N 21ST DR
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City | PHOENIX
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State | AZ
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Zip | 85015-1902
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Country | US
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Telephone | 623-419-2799
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP7356
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN172210
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License Number State | AZ
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