Individual
SUSANA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 ALTA DR, LAS VEGAS, NV 89106-4163
(702) 542-9144
Mailing address
1640 ALTA DR, LAS VEGAS, NV 89106-4163
(702) 542-9144
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
02/12/2018
Last updated
02/12/2018
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