Provider Demographics
NPI:1932863628
Name:LOPERA NINO, JUAN CAMILO
Entity type:Individual
Prefix:MR
First Name:JUAN CAMILO
Middle Name:
Last Name:LOPERA NINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 STEPPING STONE TRL
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9260
Mailing Address - Country:US
Mailing Address - Phone:330-281-7367
Mailing Address - Fax:
Practice Address - Street 1:1838 STEPPING STONE TRL
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9260
Practice Address - Country:US
Practice Address - Phone:330-281-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care