MEDICARE: MS. BRIELLE LOPEZ MS,RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0121X	Plastic Surgery Registered Nurse	333167	AZ

General Provider Information

NPI Number	:	1326903154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIELLE LOPEZ MS,RN

Provider Business Mailing Address
First Line	:	5200 S LAKESHORE DR APT 202
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1498
Country	:	US
Telephone Number	:	480-781-4016
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 E CAMELBACK RD STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2754
Country	:	US
Telephone Number	:	480-573-0082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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