Provider Demographics
NPI:1306573878
Name:LOPEZ, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
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 1:913 JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3378
Mailing Address - Country:US
Mailing Address - Phone:440-964-2774
Mailing Address - Fax:
Practice Address - Street 1:2605 N BEND RD APT 704
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-8672
Practice Address - Country:US
Practice Address - Phone:440-344-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide