Healthcare Provider Details

I. General information

NPI: 1730867847
Provider Name (Legal Business Name): EDWARD LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7576 STERLING AVE STE C-D
SAN BERNARDINO CA
92410-4273
US

IV. Provider business mailing address

742 W HIGHLAND AVE
SAN BERNARDINO CA
92405-3839
US

V. Phone/Fax

Practice location:
  • Phone: 909-381-8983
  • Fax: 909-381-2933
Mailing address:
  • Phone: 909-376-4438
  • Fax: 909-881-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA207632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: