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General NPI Number Information
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NPI Number | 1356089908
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Entity Type | Individual
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Provider Name | LUIS ANTONIO LOPEZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 10240 W INDIAN SCHOOL RD STE 155
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City | PHOENIX
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State | AZ
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Zip | 85037-5909
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Country | US
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Telephone | 623-385-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 280 ST HERMINIO ORTIZ
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City | YAUCO
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State | PR
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Zip | 00698
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Country | US
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Telephone | 787-508-3830
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10193
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License Number State | AZ
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