Provider Demographics
NPI:1932100880
Name:RODRIGUEZ-LOPEZ, JULIO A (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:A
Last Name:RODRIGUEZ-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 E UNIVERSITY DR STE 187
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-6415
Mailing Address - Country:US
Mailing Address - Phone:480-668-5000
Mailing Address - Fax:480-347-1000
Practice Address - Street 1:3600 N 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3944
Practice Address - Country:US
Practice Address - Phone:480-668-5000
Practice Address - Fax:480-668-5065
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20910208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115180Medicaid
AZ115180Medicaid
AZ780001785OtherRAILROAD MEDICARE
AZ115180Medicaid
AZWCSKQOtherSUN HEALTH GROUP #