Healthcare Provider Details

I. General information

NPI: 1285450908
Provider Name (Legal Business Name): AARON DAVID JOSEPH LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BALBOA BLVD STE 170
NORTHRIDGE CA
91325-3583
US

IV. Provider business mailing address

605 GENEVA ST UNIT 3
GLENDALE CA
91206-5306
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3400
  • Fax:
Mailing address:
  • Phone: 310-770-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: