Healthcare Provider Details

I. General information

NPI: 1730113101
Provider Name (Legal Business Name): DANIEL C LOPEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 RIVER CREST DR
RIVERSIDE CA
92507-0783
US

IV. Provider business mailing address

3551 LARCHWOOD PL
RIVERSIDE CA
92506-1237
US

V. Phone/Fax

Practice location:
  • Phone: 951-413-0964
  • Fax: 951-653-5161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14440
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA14440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: