Provider Demographics
NPI:1811649551
Name:DIAZ-LOPEZ, ERLINDA BEATRIZ (RRT)
Entity type:Individual
Prefix:
First Name:ERLINDA
Middle Name:BEATRIZ
Last Name:DIAZ-LOPEZ
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 W SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2429
Mailing Address - Country:US
Mailing Address - Phone:602-245-2402
Mailing Address - Fax:
Practice Address - Street 1:ROUTE N12 & ROUTE N7 FORT DEFIANCE AZ
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:602-245-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007136227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered