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General NPI Number Information
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NPI Number | 1619365954
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Entity Type | Individual
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Provider Name | GRETA LIZ LOPEZ DNP, AGPCNP-BC,PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 1835 N MASTICK WAY
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City | NOGALES
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State | AZ
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Zip | 85621-1064
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Country | US
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Telephone | 520-375-5000
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Fax | 520-281-4487
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Provider Business Mailing Address
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Address Line | 825 N GRAND AVE STE 100
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City | NOGALES
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State | AZ
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Zip | 85621-2385
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Country | US
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Telephone | 520-761-2133
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Fax | 520-281-1112
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP7606
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP7606
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License Number State | AZ
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