MEDICARE: ENGELBERTH ALEXANDER LOPEZ

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	225700000X	Massage Therapist	MT-28768	AZ

General Provider Information

NPI Number	:	1528750528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENGELBERTH ALEXANDER LOPEZ

Provider Business Mailing Address
First Line	:	7901 W MISSOURI AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5005
Country	:	US
Telephone Number	:	623-688-6725
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 W MISSOURI AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5005
Country	:	US
Telephone Number	:	623-688-6725
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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