Provider Demographics
NPI:1992561872
Name:LOPEZ, AZAL (STUDENT WHNP)
Entity type:Individual
Prefix:
First Name:AZAL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:STUDENT WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3741
Mailing Address - Country:US
Mailing Address - Phone:347-598-4456
Mailing Address - Fax:
Practice Address - Street 1:1600 N GRAND AVE STE 400
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2760
Practice Address - Country:US
Practice Address - Phone:719-585-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program