Provider Demographics
NPI:1952309320
Name:LOPEZ, CARLOS JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JAVIER
Last Name: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 1:521 W THOMAS RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4240
Mailing Address - Country:US
Mailing Address - Phone:602-254-0390
Mailing Address - Fax:800-846-8757
Practice Address - Street 1:521 W THOMAS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4240
Practice Address - Country:US
Practice Address - Phone:602-264-3133
Practice Address - Fax:602-252-2644
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-08-15
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ27821208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics