Provider Demographics
NPI:1730244765
Name:LOPEZ, ROSA LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:LINDA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:L
Other - Last Name:LOPEZ-COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6620 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2119
Mailing Address - Country:US
Mailing Address - Phone:520-296-3248
Mailing Address - Fax:520-296-3249
Practice Address - Street 1:6620 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-296-3248
Practice Address - Fax:520-296-3249
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ581696Medicaid