Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 13-1414 | AZ |
N | 175F00000X | Naturopath | NP416 | ME |
NPI | 1114348653 |
---|---|
Provider Name | Dr. Jorge Lopez |
First Address | Scottsdale, AZ 85257-4424 |
Second Address | Phoenix, AZ 85021-8578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2013 |
Last Update Date | 09/01/2014 |