MEDICARE: DEREK 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	103K00000X	Behavior Analyst	BEH-001054	AZ

General Provider Information

NPI Number	:	1801594650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK LOPEZ

Provider Business Mailing Address
First Line	:	4845 E THUNDERBIRD RD STE 1
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3539
Country	:	US
Telephone Number	:	602-329-3984
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 E THUNDERBIRD RD STE 1
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3539
Country	:	US
Telephone Number	:	602-329-3984
Fax Number	:

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

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/09/2026

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Directions to “ DEREK LOPEZ ” Practice Location

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