| Glenda Lopez-blaza Md, Llc | |
|
8710 N Dixie Dr Dayton OH 45414-2406 | |
| (937) 415-0501 | |
| (937) 415-0520 |
| Full Name | Glenda Lopez-blaza Md, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8710 N Dixie Dr, Dayton, Ohio |
| Authorized Official Name and Position | Glenda Joy Lopez-blaza (OWNER) |
| Authorized Official Contact | 9374150501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenda Lopez-blaza Md, Llc 8710 N Dixie Dr Dayton OH 45414-2406 Ph: (937) 415-0501 | Glenda Lopez-blaza Md, Llc 8710 N Dixie Dr Dayton OH 45414-2406 Ph: (937) 415-0501 |
| NPI Number | 1033162169 |
|---|---|
| Provider Enumeration Date | 05/18/2006 |
| Last Update Date | 06/20/2011 |
| Medicare PECOS PAC ID | 4486745163 |
|---|---|
| Medicare Enrollment ID | O20070809000514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033162169 | NPI | - | NPPES |
| 0983002 | Medicaid | OH | |
| 2988272 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Glenda Lopez-blaza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356333967 PECOS PAC ID: 6901839737 Enrollment ID: I20100301000825 |
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