Provider Demographics
NPI:1235237298
Name:ROSADO-LOPEZ, LUIS J (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:J
Last Name:ROSADO-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29675
Mailing Address - Street 2:DEPT 2032
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9675
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:3987 E PARADISE FALLS DR
Practice Address - Street 2:SUITE 118
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6692
Practice Address - Country:US
Practice Address - Phone:520-408-6955
Practice Address - Fax:520-408-9537
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ18525208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0719260OtherBCBSAZ
AZ18525OtherAZ MEDICAL LICENSE
AZ290891Medicaid
AZ290891Medicaid
AZ18525OtherAZ MEDICAL LICENSE
AZAZ0719260OtherBCBSAZ
AZZ70988Medicare PIN