Provider Demographics
NPI:1407354558
Name:LOPEZ, ALEXANDRA GABRIELA (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GABRIELA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 CRYSTAL VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3242
Mailing Address - Country:US
Mailing Address - Phone:703-405-3681
Mailing Address - Fax:
Practice Address - Street 1:5165 S FORT APACHE RD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1764
Practice Address - Country:US
Practice Address - Phone:702-981-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.6292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist