Individual
GUSTAVO A LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9169 W VAN BUREN ST, TOLLESON, AZ 85353-2942
(602) 283-5732
(602) 314-4579
Mailing address
9169 W VAN BUREN ST, TOLLESON, AZ 85353-2942
(602) 283-5732
(602) 314-4579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42153
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441076
—
AZ
Enumeration date
07/08/2009
Last updated
12/26/2018
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