Provider Demographics
NPI:1649938259
Name:LOPEZ, KEVIN STEVEN (PA-C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:STEVEN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 EDNA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3010
Mailing Address - Country:US
Mailing Address - Phone:702-443-4097
Mailing Address - Fax:
Practice Address - Street 1:871 CORONADO CENTER DR STE 141
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3977
Practice Address - Country:US
Practice Address - Phone:702-566-2400
Practice Address - Fax:702-433-2477
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant