Healthcare Provider Details

I. General information

NPI: 1912219916
Provider Name (Legal Business Name): MS. DELMY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N AZUSA AVE STE C
COVINA CA
91722-1257
US

IV. Provider business mailing address

14934 LOFTHILL DR
LA MIRADA CA
90638-5138
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-9940
  • Fax: 626-858-9366
Mailing address:
  • Phone: 714-609-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number55025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: