Healthcare Provider Details

I. General information

NPI: 1295541522
Provider Name (Legal Business Name): MELINA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N CULVER AVE
COMPTON CA
90220-2213
US

IV. Provider business mailing address

705 N CULVER AVE
COMPTON CA
90220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 310-505-8178
  • Fax:
Mailing address:
  • Phone: 310-505-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: