Healthcare Provider Details

I. General information

NPI: 1881953487
Provider Name (Legal Business Name): LORENZO LOPEZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6810
US

IV. Provider business mailing address

722 MEDICAL CENTER DR E STE 101
CLOVIS CA
93611-6810
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-9500
  • Fax: 559-297-9572
Mailing address:
  • Phone: 559-297-9500
  • Fax: 559-297-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA62591
License Number StateCA

VIII. Authorized Official

Name: LORENZO LOPEZ
Title or Position: MD
Credential: MD
Phone: 559-297-9500