Healthcare Provider Details

I. General information

NPI: 1275977498
Provider Name (Legal Business Name): GEORGE LOPEZ CHUA NP-C, MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N BEAUDRY AVENUE, NURSING SERVICES, ROYBAL ANNEX
LOS ANGELES CA
90012-2009
US

IV. Provider business mailing address

121 N. BEAUDRY AVENUE, NURSING SERVICES, ROYBAL ANNEX
LOS ANGELES CA
90012-2009
US

V. Phone/Fax

Practice location:
  • Phone: 213-202-7580
  • Fax: 213-580-6558
Mailing address:
  • Phone: 213-202-7580
  • Fax: 213-580-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number675609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: