1669087243 NPI number — LINALEEA LOPEZ NP

Table of content: LINALEEA LOPEZ NP (NPI 1669087243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669087243 NPI number — LINALEEA LOPEZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
LINALEEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1669087243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 603949
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-3949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-350-0351
Provider Business Mailing Address Fax Number:
919-350-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DUKE CLINIC TRAUMA SURGERY 2B/2C
Provider Second Line Business Practice Location Address:
40 DUKE MEDICINE CIRCLE
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-681-3784
Provider Business Practice Location Address Fax Number:
919-668-4369
Provider Enumeration Date:
09/10/2020

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: 363LA2100X , with the licence number:  2020009465 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 5013973 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1669087243 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".