Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 32357 | AZ |
Y | 208600000X | Surgeon | 32357 | AZ |
NPI | 1003872318 |
---|---|
Provider Name | Dr. Raul A. Lopez Gonzalez |
First Address | Mesa, AZ 85206-4709 |
Second Address | Mesa, AZ 85206-4709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
871253 | (05) | AZ |
C78264 | (02) | AZ |