Provider Demographics
NPI:1376123992
Name:LOPEZ, KARLA IVETH (MC56463)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:IVETH
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MC56463
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 56TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7476
Mailing Address - Country:US
Mailing Address - Phone:253-310-8021
Mailing Address - Fax:
Practice Address - Street 1:7719 56TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7476
Practice Address - Country:US
Practice Address - Phone:253-310-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56463171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty