Individual
JOSE LOPEZ UBALDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
158511
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
4359
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051198
—
NC
Enumeration date
12/16/2006
Last updated
05/24/2023
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