Provider Demographics
NPI:1861021719
Name:LOPES, HEITOR GIOVANNI
Entity type:Individual
Prefix:
First Name:HEITOR
Middle Name:GIOVANNI
Last Name:LOPES
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 1:413 LILLY RD NE
Mailing Address - Street 2:MS 02H16
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5133
Mailing Address - Country:US
Mailing Address - Phone:425-284-1547
Mailing Address - Fax:425-284-1546
Practice Address - Street 1:413 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:425-284-1547
Practice Address - Fax:425-284-1546
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-08-24
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
WA61462558207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology