Provider Demographics
NPI:1134785850
Name:MASON-LOPEZ, DARLENE (MT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MASON-LOPEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 N 16TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3242
Mailing Address - Country:US
Mailing Address - Phone:602-367-2857
Mailing Address - Fax:
Practice Address - Street 1:5320 N 16TH ST STE 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3242
Practice Address - Country:US
Practice Address - Phone:602-367-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03739P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist