Individual
JOE LOPEZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2598 S BUCKAROO TRL, GILBERT, AZ 85297-6576
(602) 790-9808
Mailing address
2598 S BUCKAROO TRL, GILBERT, AZ 85297-6576
(602) 790-9808
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0373
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0373
STATE LICENSE
AZ
Enumeration date
10/10/2005
Last updated
07/08/2007
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