Provider Demographics
NPI:1730348087
Name:LOPEZ, ERIC NELSON JR (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NELSON
Last Name:LOPEZ
Suffix:JR
Gender:
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 HOLIDAY TOWER CONDO, ROUTE 4, APT 707
Mailing Address - Street 2:
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:760-480-4685
Mailing Address - Fax:
Practice Address - Street 1:BLDG 50, FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-339-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA56031363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant