Provider Demographics
NPI:1376177527
Name:LOPEZ PLAZA, ANABELL MARINA
Entity Type:Individual
Prefix:
First Name:ANABELL
Middle Name:MARINA
Last Name:LOPEZ PLAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BERRYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2058
Mailing Address - Country:US
Mailing Address - Phone:631-882-3434
Mailing Address - Fax:
Practice Address - Street 1:12 BERRYWOOD CT
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2058
Practice Address - Country:US
Practice Address - Phone:631-882-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024737363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical