Provider Demographics
NPI:1962782599
Name:LOPEZ, SARAH MAUREEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MAUREEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15362 ROLLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2963
Mailing Address - Country:US
Mailing Address - Phone:503-888-2977
Mailing Address - Fax:
Practice Address - Street 1:428 S GILBERT RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2261
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-535-0962
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4937363A00000X
CA52111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant