Healthcare Provider Details

I. General information

NPI: 1508787102
Provider Name (Legal Business Name): JOSE ALFREDO LOPEZ HERRERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9907 WALKER ST
CYPRESS CA
90630-3827
US

IV. Provider business mailing address

275 E 46TH ST
SAN BERNARDINO CA
92404-1250
US

V. Phone/Fax

Practice location:
  • Phone: 714-581-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: