Basic Information
| Provider Information | |||||||||
| NPI: | 1649726852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | SALVADOR | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 HOYT LANE | ||||||||
| Address2: | |||||||||
| City: | WAPATO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989519753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093883388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 HOLTON AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094522508 | ||||||||
| FaxNumber: | 5094527316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | OA60743170 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.