Provider Demographics
NPI:1154605699
Name:LOPEZ, VARDYNG
Entity type:Individual
Prefix:MR
First Name:VARDYNG
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WASHINGTON ST STE 302
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4516
Mailing Address - Country:US
Mailing Address - Phone:703-533-1193
Mailing Address - Fax:703-533-1192
Practice Address - Street 1:100 N WASHINGTON ST STE 302
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4516
Practice Address - Country:US
Practice Address - Phone:703-533-1193
Practice Address - Fax:703-533-1192
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA260677758164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse