Individual
MS. ELIZABETH LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
7734 N 59TH AVE, GLENDALE, AZ 85301-7816
(602) 569-3999
(602) 569-3887
Mailing address
1533 E WILLETTA ST, PHOENIX, AZ 85006-2935
(602) 606-7653
(602) 569-3887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3277
AZ
363AM0700X
Medical Physician Assistant
3277
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000083
—
AZ
01
—
Z147594
PART B
AZ
Enumeration date
12/18/2006
Last updated
07/12/2023
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