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Organization

GLENDA LOPEZ-BLAZA MD, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GLENDA JOY LOPEZ-BLAZA MD (OWNER)
(937) 415-0501
Entity
Organization

Contact information

Practice address
8710 N DIXIE DR, DAYTON, OH 45414-2406
(937) 415-0501
(937) 415-0520
Mailing address
8710 N DIXIE DR, DAYTON, OH 45414-2406
(937) 415-0501
(937) 415-0520

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0983002
OH
05
2988272
OH
Enumeration date
05/18/2006
Last updated
06/20/2011
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