1588860621 NPI number — DR. LUZ E LOPEZ DPM

Table of content: DR. LUZ E LOPEZ DPM (NPI 1588860621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588860621 NPI number — DR. LUZ E LOPEZ DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
LUZ
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588860621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11711 NE 12TH ST
Provider Second Line Business Mailing Address:
STE 1B
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-389-0079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11711 NE 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 1-B
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-389-0079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO00000824 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0227705 . This is a "L&I INSURANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 756480615 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8494924 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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