Healthcare Provider Details

I. General information

NPI: 1164456117
Provider Name (Legal Business Name): JULIE ANN VALDE LOPEZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 CAMINO DOS RIOS SUITE #401
NEWBURY PARK CA
91320-1134
US

IV. Provider business mailing address

2814 CAMINO DOS RIOS SUITE #401
NEWBURY PARK CA
91320-1134
US

V. Phone/Fax

Practice location:
  • Phone: 805-499-7676
  • Fax: 805-375-8642
Mailing address:
  • Phone: 805-499-7676
  • Fax: 805-375-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: