Individual
KENNETH JESSE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-6652
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-6652
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0116039223
VA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
06/18/2024
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