Healthcare Provider Details

I. General information

NPI: 1699702795
Provider Name (Legal Business Name): FRANK EPHRAIM LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FRESNO ST SUITE 102
FRESNO CA
93721-1439
US

IV. Provider business mailing address

2900 FRESNO ST SUITE 102
FRESNO CA
93721-1439
US

V. Phone/Fax

Practice location:
  • Phone: 559-307-8206
  • Fax: 559-268-2929
Mailing address:
  • Phone: 559-229-2900
  • Fax: 559-268-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: