Provider Demographics
NPI:1952784605
Name:LOPEZ, MONICA C (APN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 E RAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6092
Mailing Address - Country:US
Mailing Address - Phone:480-785-1006
Mailing Address - Fax:
Practice Address - Street 1:4430 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6092
Practice Address - Country:US
Practice Address - Phone:480-785-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012677363LF0000X
AZAP11380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILML4135061OtherDEA
IL13581910OtherCAQH