Healthcare Provider Details

I. General information

NPI: 1245704717
Provider Name (Legal Business Name): DANIEL LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 28TH ST
BAKERSFIELD CA
93301-1924
US

IV. Provider business mailing address

4324 THATCH AVE
BAKERSFIELD CA
93313-2953
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: