Provider Demographics
NPI:1255675161
Name:LOPEZ, AIDA LUZ (LPN)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:LUZ
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2719
Mailing Address - Country:US
Mailing Address - Phone:216-973-9965
Mailing Address - Fax:
Practice Address - Street 1:3242 W 112TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2719
Practice Address - Country:US
Practice Address - Phone:216-973-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH108733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH108733OtherOHIO BOARD OF NURSING