Healthcare Provider Details

I. General information

NPI: 1922971910
Provider Name (Legal Business Name): ALEX DOMINICK LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

117 W 94TH ST
LOS ANGELES CA
90003-4001
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4111
  • Fax: 562-984-5610
Mailing address:
  • Phone: 213-356-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: