Individual
ISIS KARENSHA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1223 NE BARAGAR AVE, ROSEBURG, OR 97471-5621
(541) 236-5997
(541) 236-5291
Mailing address
1223 NE BARAGAR AVE, ROSEBURG, OR 97470
(541) 236-5997
(541) 236-5291
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17016
OR
Other
Enumeration date
03/13/2014
Last updated
03/13/2014
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