Provider Demographics
NPI:1124081823
Name:LOPEZ, LUZ ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:ANGELA
Last Name:LOPEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:ANGELA
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3130 E BASELINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7290
Mailing Address - Country:US
Mailing Address - Phone:480-539-7618
Mailing Address - Fax:480-539-1704
Practice Address - Street 1:3130 E BASELINE RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7290
Practice Address - Country:US
Practice Address - Phone:480-539-7618
Practice Address - Fax:480-900-8884
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33381208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000490Medicaid