Provider Demographics
NPI:1588937775
Name:LOPEZ, PEDRO JOSE (LPN)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JOSE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 NORTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3925
Mailing Address - Country:US
Mailing Address - Phone:585-775-1219
Mailing Address - Fax:
Practice Address - Street 1:1206 NORTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3925
Practice Address - Country:US
Practice Address - Phone:585-775-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288883-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse