Provider Demographics
NPI:1710793054
Name:SOCORRO LOPEZ, LUIS ENRIQUE
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:SOCORRO LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9792 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8411
Mailing Address - Country:US
Mailing Address - Phone:702-241-8395
Mailing Address - Fax:
Practice Address - Street 1:2911 N TENAYA WAY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0488
Practice Address - Country:US
Practice Address - Phone:702-990-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV854668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily