Healthcare Provider Details

I. General information

NPI: 1871503706
Provider Name (Legal Business Name): ELVA LOPEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 EYE ST SUITE 110
BAKERSFIELD CA
93301-2064
US

IV. Provider business mailing address

2525 EYE ST SUITE 110
BAKERSFIELD CA
93301-2064
US

V. Phone/Fax

Practice location:
  • Phone: 661-637-0137
  • Fax: 661-637-0177
Mailing address:
  • Phone: 661-637-0137
  • Fax: 661-637-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG73158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: