Healthcare Provider Details

I. General information

NPI: 1942309331
Provider Name (Legal Business Name): MARIA EDIT LOPEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 E IMPERIAL HWY
LYNWOOD CA
90262-2655
US

IV. Provider business mailing address

3590 E IMPERIAL HWY
LYNWOOD CA
90262-2655
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax: 310-438-2194
Mailing address:
  • Phone: 562-867-7999
  • Fax: 310-438-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: