Provider Demographics
NPI:1558143099
Name:ESPIRITU LOPEZ, SHIARA PATRICIA (FNP-C)
Entity type:Individual
Prefix:
First Name:SHIARA
Middle Name:PATRICIA
Last Name:ESPIRITU LOPEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 W. NORTHERN AVE SUITE 106
Mailing Address - Street 2:5048 W. NORTHERN AVE SUITE 106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301
Mailing Address - Country:US
Mailing Address - Phone:623-435-0190
Mailing Address - Fax:623-435-0193
Practice Address - Street 1:5048 W. NORTHERN AVE SUITE 106
Practice Address - Street 2:5048 W. NORTHERN AVE SUITE 106
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301
Practice Address - Country:US
Practice Address - Phone:623-435-0190
Practice Address - Fax:623-435-0193
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ217803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty