Provider Demographics
NPI:1104437938
Name:LOPEZ, JOSEFA BUSTOS
Entity type:Individual
Prefix:
First Name:JOSEFA
Middle Name:BUSTOS
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E TROPICANA AVE STE 199
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8323
Mailing Address - Country:US
Mailing Address - Phone:725-214-7776
Mailing Address - Fax:725-214-7768
Practice Address - Street 1:1516 E TROPICANA AVE STE 199
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8323
Practice Address - Country:US
Practice Address - Phone:725-214-7776
Practice Address - Fax:725-214-7768
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2106087514Medicaid