Healthcare Provider Details

I. General information

NPI: 1346341070
Provider Name (Legal Business Name): LUIS E LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

IV. Provider business mailing address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

V. Phone/Fax

Practice location:
  • Phone: 213-746-1037
  • Fax: 213-746-9379
Mailing address:
  • Phone: 213-746-1037
  • Fax: 213-746-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG37689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: