Healthcare Provider Details

I. General information

NPI: 1194812685
Provider Name (Legal Business Name): ERIC JOSUE CID-LOPEZ B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 BELLFLOWER BLVD
BELLFLOWER CA
90706-3859
US

IV. Provider business mailing address

364 S SIERRA MADRE BLVD
PASADENA CA
91107-5231
US

V. Phone/Fax

Practice location:
  • Phone: 562-866-8956
  • Fax:
Mailing address:
  • Phone: 626-535-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: