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NPI Code Detail

MEDICARE: CECILIA LOPEZ PA

MEDICARE: CECILIA LOPEZ PA
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
1363A00000XPhysician AssistantPA12722CA

General Provider Information

NPI Number : 1801069943
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECILIA LOPEZ PA
Provider Business Mailing Address
First Line : 1601 MONTE VISTA AVE
Second Line : STE 100
City : CLAREMONT
State : CA
Zip : 91711-6601
Country : US
Telephone Number : 909-335-4188
Fax Number :
Provider Business Practice Location Address
First Line : 4279 TIERRA REJADA RD
Second Line :
City : MOORPARK
State : CA
Zip : 93021-3775
Country : US
Telephone Number : 805-222-2323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2008
Last Update Date : 08/01/2023

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Directions to “ CECILIA LOPEZ PA” Practice Location

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