Individual
BASIA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5698 W GLEN EAGLE DR, WEST VALLEY, UT 84128-4013
(801) 969-4181
Mailing address
1767 E DOWNINGTON AVE, SALT LAKE CITY, UT 84108-2909
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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