Provider Demographics
NPI:1063053866
Name:LOPEZ, JESUS (RPSGT)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 N UNIVERSITY PKWY # 113
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1543
Mailing Address - Country:US
Mailing Address - Phone:323-286-5703
Mailing Address - Fax:
Practice Address - Street 1:1461 ARCHMORE LOOP
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:323-286-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic