Provider Demographics
NPI:1295354157
Name:LOPEZ, ERICK DANIEL
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:DANIEL
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 1:2201 SOFIA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-1444
Mailing Address - Country:US
Mailing Address - Phone:956-240-3191
Mailing Address - Fax:
Practice Address - Street 1:7600 N LA CHOLLA BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4242
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
AZ73919207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program