Active NPI
Anthony Michael Lopez, LMT
- Community Health Worker
- Portland, OR
National Provider Identifier
1114394079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 21295
- Practice address
- 6504 NE Siskiyou St
Portland, OR 97213-4572 - Phone
- (901) 409-1352
- NPI assigned
- Aug 27, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 21295 | OR | Primary |
Addresses
Primary practice location
6504 NE Siskiyou St
Portland, OR 97213-4572
Mailing address
1307 SE 17TH Ave
Portland, OR 97214-3797
Phone (503) 310-3087
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21295 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1114394079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1307 SE 17TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972143797",
"telephone_number": "503-310-3087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6504 NE SISKIYOU ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972134572",
"telephone_number": "901-409-1352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "ANTHONY",
"middle_name": "MICHAEL",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-27",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "21295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.