Organization
PHOENIX INDIAN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN J. LOPEZ REGISTERED NURSE (PUBLIC HEALTH NURSE)
(602) 248-4194
Entity
Organization
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 248-4194
(602) 200-5381
Mailing address
1244 E BETHANY HOME RD, 36-A, PHOENIX, AZ 85014-2043
(602) 266-2281
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN051810
AZ
Other
Enumeration date
01/22/2007
Last updated
08/22/2020
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