MEDICARE: ENRIQUE SION LOPEZ M.D.

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	208000000X	Pediatrics Physician	200101237	NC
2	208000000X	Pediatrics Physician	35764	AZ

General Provider Information

NPI Number	:	1578572087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE SION LOPEZ M.D.

Provider Business Mailing Address
First Line	:	6745 N 51ST DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-3425
Country	:	US
Telephone Number	:	623-847-5300
Fax Number	:	623-847-5304

Provider Business Practice Location Address
First Line	:	6745 N 51ST DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-3425
Country	:	US
Telephone Number	:	623-847-5300
Fax Number	:	623-847-5304

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/13/2024

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