Provider Demographics
NPI:1497462865
Name:LOPEZ, TRACY CLARIBEL
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CLARIBEL
Last Name:LOPEZ
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 1:5055 SUN VALLEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-8296
Mailing Address - Country:US
Mailing Address - Phone:775-329-6300
Mailing Address - Fax:775-323-3140
Practice Address - Street 1:5055 SUN VALLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-8296
Practice Address - Country:US
Practice Address - Phone:775-329-6300
Practice Address - Fax:775-323-3140
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5264172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker