Doctor Name: | MRS. JOEY EDITH VICTORIA-LOPEZ |
NPI Number: | 1053668541 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA159636 |
Business Practice Address: | 450 Tatone Street Boardman, OR - 97818 |
Business Phone Number: | 5414817212 |
Business Fax Number: | 5414812020 |
Mailing Address: | Po Box 397, BOARDMAN |
State: | OR |
Postal Code: | 978180397 |
Phone Number: | 5414817212 |
Fax Number: | 5414812020 |
NPI Enumeration Date: | 08/14/2012 |
NPI Last Update Date: | 08/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA159636 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |