Provider Demographics
NPI:1326477134
Name:LOPEZ, JUAN JOSE (RN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6223 N 21ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1902
Mailing Address - Country:US
Mailing Address - Phone:623-419-2799
Mailing Address - Fax:
Practice Address - Street 1:6223 N 21ST DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1902
Practice Address - Country:US
Practice Address - Phone:623-419-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN172210163W00000X
AZAP7356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004494Medicaid
AZ004494Medicaid