Individual
GUILLERMO ANTONIO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
650 HUEBNER RD, FT RILEY, KS 66442-4030
(808) 726-8454
Mailing address
650 HUEBNER RD, FT RILEY, KS 66442-4030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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