Healthcare Provider Details

I. General information

NPI: 1952705964
Provider Name (Legal Business Name): LAURA ANNE LOPEZ MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

IV. Provider business mailing address

4455 W 117TH ST STE 200
HAWTHORNE CA
90250-2240
US

V. Phone/Fax

Practice location:
  • Phone: 310-219-2000
  • Fax:
Mailing address:
  • Phone: 310-219-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: