Individual
BIANCA MICHELLE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13677 W MCDOWELL RD, GOODYEAR, AZ 85395-2635
(623) 882-1500
Mailing address
22137 W MESQUITE DR, BUCKEYE, AZ 85326-5538
(602) 814-6812
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8679
AZ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/05/2021
Last updated
12/15/2021
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