Individual
MR. ABRAHAM DAGOBERTO LOPEZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5102 W CAMPBELL AVE, PHOENIX, AZ 85031-1703
(623) 848-5000
Mailing address
4518 W PARADISE DR, GLENDALE, AZ 85304-3027
(602) 320-0580
(602) 354-4171
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2816
AZ
363A00000X
Physician Assistant
Primary
2816
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3987220
EYECARE
AZ
01
—
453051001
GROUP HEALTH GROUP
AZ
05
—
817827
—
AZ
01
—
860373636
HUMANA-GROUP #
AZ
01
—
AW1436
HEALTHNET GROUP
AZ
Enumeration date
12/15/2005
Last updated
12/22/2020
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