Individual
PAMELA LOPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10809 W RIO VISTA LN, AVONDALE, AZ 85323-1161
(623) 936-4390
Mailing address
10809 W RIO VISTA LN, AVONDALE, AZ 85323-1161
(623) 936-4390
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
9401
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
912156
AHCCCS ID
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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