Provider Information for 1285133256
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SHANE KEITH LOPEZ
Sex: Male
NPI: 1285133256
Last Updated: 2019-03-11
Certification Date:
Certification Date:
Details
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NPI | 1285133256 | ||||||||
Enumeration Date | 2018-02-06 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 115 KEATING DR BELLE CHASSE, LA 70037-1629 United States Phone: 504-393-5750 | Fax:318-251-4659 | ||||||||
Primary Practice Address | 115 KEATING DR BELLE CHASSE, LA 70037 United States Phone: 504-393-5750 | Fax: | ||||||||
Secondary Practice Address(es) | 617 S TRENTON ST | ||||||||
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