Individual
ANTHONY MICHAEL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6504 NE SISKIYOU ST, PORTLAND, OR 97213-4572
(901) 409-1352
Mailing address
1307 SE 17TH AVE, PORTLAND, OR 97214-3797
(503) 310-3087
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
21295
OR
Other
Enumeration date
08/27/2015
Last updated
08/24/2016
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