Provider Demographics
NPI:1144015504
Name:LOPEZ, BRITANY DESIREE
Entity type:Individual
Prefix:
First Name:BRITANY
Middle Name:DESIREE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 W HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1824
Mailing Address - Country:US
Mailing Address - Phone:602-863-4203
Mailing Address - Fax:602-863-4216
Practice Address - Street 1:14877 W BELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7610
Practice Address - Country:US
Practice Address - Phone:602-863-4203
Practice Address - Fax:602-863-4216
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE15567237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist