Provider Demographics
NPI:1689429326
Name:LOPEZ, ALAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 W SAHARA AVE STE D11
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6004
Mailing Address - Country:US
Mailing Address - Phone:702-478-6983
Mailing Address - Fax:
Practice Address - Street 1:3170 W SAHARA AVE STE D11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6004
Practice Address - Country:US
Practice Address - Phone:702-478-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV830771363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health