Individual provider Active NPI

Elizabeth Lopez, P.A.-C.

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1255494431
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3277 Issued in AZ
Practice address
7734 N 59TH Ave
Glendale, AZ 85301-7816
Phone
(602) 569-3999
Fax
(602) 569-3887
NPI assigned
Dec 18, 2006
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3277 AZ Primary
Medical Physician Assistant 363AM0700X 3277 AZ

Addresses

Primary practice location

7734 N 59TH Ave
Glendale, AZ 85301-7816

Mailing address

1533 E Willetta St
Phoenix, AZ 85006-2935
Phone (602) 606-7653

Other identifiers 2

IdentifierTypeStateIssuer
000083MedicaidAZ
Z147594OtherAZPART B

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111018000849 AZ Practitioner - Physician Assistant 4587836424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinica la Familia PCGroup PAC ID 4082694781, 38 clinicians

Practice addresses (Care Compare)

1315 W Southern Ave
Tempe, AZ 85282-4519
Phone (602) 569-3999

1533 E Willetta St
Phoenix, AZ 85006-2935
Phone (602) 569-3999

616 E Southern Ave
Suite 103
Mesa, AZ 85204-4941
Phone (602) 569-3999

7734 N 59TH Ave
Glendale, AZ 85301-7816
Phone (602) 569-3999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3277AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Kidney Associates PLC PastSince Aug 25, 2019 Accepting new patients
Msmancina Associates Arizona, PLLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1255494431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 E WILLETTA ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062935",
            "telephone_number": "602-606-7653",
            "fax_number": "602-569-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7734 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853017816",
            "telephone_number": "602-569-3999",
            "fax_number": "602-569-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3277",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3277",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000083",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B",
            "identifier": "Z147594",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.