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General NPI Number Information
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NPI Number | 1588956478
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Entity Type | Individual
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Provider Name | ROXANNE DIANE LOPEZ LMT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 503 E PLAZA CIR DR SUITE B
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4924
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Country | US
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Telephone | 623-932-0637
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Fax | 623-932-0750
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Provider Business Mailing Address
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Address Line | 503 E PLAZA CIR DR SUITE B
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-4924
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Country | US
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Telephone | 623-932-0637
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Fax | 623-932-0750
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MT-10183
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License Number State | AZ
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