Healthcare Provider Details

I. General information

NPI: 1720102056
Provider Name (Legal Business Name): MARIA N HERNANDEZ-LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 GOODRICH BLVD
COMMERCE CA
90022-5111
US

IV. Provider business mailing address

PO BOX 3570
SOUTH PASADENA CA
91031-6570
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-1337
  • Fax:
Mailing address:
  • Phone: 323-725-1337
  • Fax: 323-278-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA051414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: