Provider Demographics
NPI:1417273574
Name:LOPEZ, ANGELA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0213
Mailing Address - Country:US
Mailing Address - Phone:408-642-0344
Mailing Address - Fax:
Practice Address - Street 1:30 THUNDERHEAD TRAIL
Practice Address - Street 2:
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637
Practice Address - Country:US
Practice Address - Phone:408-642-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31529111N00000X
AZ8650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor