Doctor Name: | JENA MARIE LOPEZ |
NPI Number: | 1386607612 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | MD00048855 |
Business Practice Address: | 1415 E Kincaid Street Mount Vernon, WA - 982744126 |
Business Phone Number: | 3604244111 |
Business Fax Number: | |
Mailing Address: | 1415 E Kincaid Street, MOUNT VERNON |
State: | WA |
Postal Code: | 982744126 |
Phone Number: | 3604244111 |
Fax Number: | |
NPI Enumeration Date: | 04/08/2006 |
NPI Last Update Date: | 03/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD00048855 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |