Provider Demographics
NPI:1689345092
Name:LOPEZ, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RANCHO DR STE E33
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4833
Mailing Address - Country:US
Mailing Address - Phone:702-483-6302
Mailing Address - Fax:702-483-6313
Practice Address - Street 1:501 S RANCHO DRIVE ACE PERSONAL CARE LLC
Practice Address - Street 2:SUITE E-33
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-483-6302
Practice Address - Fax:702-483-6313
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant