Provider Demographics
NPI:1265872543
Name:LOPES, REQUEL Y (LAC)
Entity type:Individual
Prefix:
First Name:REQUEL
Middle Name:Y
Last Name:LOPES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 EVANS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9653
Mailing Address - Country:US
Mailing Address - Phone:919-263-4331
Mailing Address - Fax:
Practice Address - Street 1:1616 EVANS RD STE 205
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9653
Practice Address - Country:US
Practice Address - Phone:954-951-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01424171100000X
FL3381171100000X
NC2119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist