Provider Demographics
NPI:1295619450
Name:REYES LOPEZ, MAURO FRANCISCO
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:FRANCISCO
Last Name:REYES LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3522
Mailing Address - Country:US
Mailing Address - Phone:541-608-6868
Mailing Address - Fax:
Practice Address - Street 1:500 MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3522
Practice Address - Country:US
Practice Address - Phone:541-608-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113473172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker