Individual
MRS. MARIAH NICOLE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4000 MIAMISBURG CENTERVILLE RD STE 230, MIAMISBURG, OH 45342-7615
(937) 433-5309
Mailing address
2939 SUNNY DR, BEAVERCREEK, OH 45434-6333
(937) 321-4494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005750RX
OH
Other
Enumeration date
11/26/2018
Last updated
08/16/2022
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