Provider Demographics
NPI:1316138712
Name:LOPEZ, JOYCE M (MBA)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16632 S 29TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8518
Mailing Address - Country:US
Mailing Address - Phone:480-940-0938
Mailing Address - Fax:
Practice Address - Street 1:16632 S 29TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8518
Practice Address - Country:US
Practice Address - Phone:480-940-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10719322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children