Individual
MR. GABRIEL THOMAS LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7419 W PLANADA LN, GLENDALE, AZ 85310-5886
(602) 571-3364
Mailing address
7419 W PLANADA LN, GLENDALE, AZ 85310-5886
(602) 571-3364
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7939
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/13/2018
Last updated
08/17/2020
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