MEDICARE: DR. ANTHONY J LOPRESTI D.O.

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	207Q00000X	Family Medicine Physician	2OA6194	CA
2	207K00000X	Allergy & Immunology Physician	2OA6194	CA

General Provider Information

NPI Number	:	1417054321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY J LOPRESTI D.O.

Provider Business Mailing Address
First Line	:	47 MONTE VISTA AVE
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94590-3926
Country	:	US
Telephone Number	:	707-643-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 GLEN COVE MARINA RD E STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-638-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/17/2016

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