Individual ProviderJose LopezPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9015 N 3rd St, Phoenix, AZ 85020-2444(480) 882-4545PECOS EnrollmentBased on the most recent information from CMS, provider Jose Lopez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1952040131Provider TypeIndividualFull NameLopez, JoseCredentialPA-CGenderMaleSole ProprietorYesEnumeration Date6/3/2022Last Updated10/24/2022Contact InformationPractice LocationPractice Address9015 N 3rd St, Phoenix, AZ 85020-2444Phone(480) 882-4545Fax(602) 870-6348Mailing LocationMailing Address7500 N Dreamy Draw Dr Ste 145, Phoenix, AZ 85020-4668Phone(480) 882-4545Fax(480) 882-5814Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense9353ArizonaProvider IdentifiersIDDescriptionIssuerID151258DescriptionMedicaidIssuerUnlistedArizona