Healthcare Provider Details

I. General information

NPI: 1649273293
Provider Name (Legal Business Name): D. A. LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: D. A. LOPEZ M.D.

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL STE 260
CORONADO CA
92118-1987
US

IV. Provider business mailing address

230 PROSPECT PL STE 260
CORONADO CA
92118-1987
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-1146
  • Fax: 619-437-1912
Mailing address:
  • Phone: 619-437-1146
  • Fax: 619-437-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG10411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: