Individual
MARTIN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
483 W SEED FARM RD, SACATON, AZ 85147-0001
(602) 528-7106
Mailing address
PO BOX 38, SACATON, AZ 85147-0001
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
BH-123456
AZ
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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