Provider Demographics
NPI:1073626016
Name:LOPEZ, BETH ANN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S DOBSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5680
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:480-899-7599
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5680
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:480-899-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical