Provider Demographics
NPI:1548042807
Name:LOPEZ, LISA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CENTRAL AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3984
Mailing Address - Country:US
Mailing Address - Phone:727-999-1617
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3984
Practice Address - Country:US
Practice Address - Phone:727-999-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy