MEDICARE: ANGELICA MARIA LOPEZ MD

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	208000000X	Pediatrics Physician	39579	OK

General Provider Information

NPI Number	:	1689261877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA MARIA LOPEZ MD

Provider Business Mailing Address
First Line	:	5320 W CHESTNUT AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-3563
Country	:	US
Telephone Number	:	580-701-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 W CHESTNUT AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-3563
Country	:	US
Telephone Number	:	580-701-0100
Fax Number	:

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/17/2025

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