Healthcare Provider Details

I. General information

NPI: 1083241384
Provider Name (Legal Business Name): HUGO ERNESTO LOPEZ MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41696 ROAD 128
OROSI CA
93647-2059
US

IV. Provider business mailing address

41696 ROAD 128
OROSI CA
93647-2059
US

V. Phone/Fax

Practice location:
  • Phone: 559-528-6966
  • Fax: 559-528-3665
Mailing address:
  • Phone: 559-528-6966
  • Fax: 559-528-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: