Provider Demographics
NPI:1205298676
Name:CONTRERAS LOPEZ, ANDREA (NMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CONTRERAS LOPEZ
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N 24TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1836
Mailing Address - Country:US
Mailing Address - Phone:602-581-7650
Mailing Address - Fax:602-581-7651
Practice Address - Street 1:2401 N 24TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1836
Practice Address - Country:US
Practice Address - Phone:602-273-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1539208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice