| Doctor Name: | MR. BRYAN LOPEZ |
| NPI Number: | 1215306675 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | IDC |
| License Number: | |
| Business Practice Address: | Psc 455 Box 182 Medical Department, Navspecwaunit One Fpo, AP - 965401182 |
| Business Phone Number: | 6713396287 |
| Business Fax Number: | |
| Mailing Address: | Psc 455 Box 182, Medical Department FPO |
| State: | AP |
| Postal Code: | 965401182 |
| Phone Number: | 6713396287 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2015 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |