MEDICARE: RAUL LOPEZ, M.D., A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1144562190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAUL LOPEZ, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4521 EAST CESAR CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-269-4509
Fax Number	:

Provider Business Practice Location Address
First Line	:	4521 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-269-4509
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAUL LOPEZ
Credential	:	MD
Telephone Number	:	323-269-4509

Provider Enumeration Date	:	03/17/2013
Last Update Date	:	03/17/2013

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