Healthcare Provider Details

I. General information

NPI: 1982535993
Provider Name (Legal Business Name): MR. WAYNE LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15325 WASHINGTON AVE STE B
SAN LEANDRO CA
94579-1811
US

IV. Provider business mailing address

14350 BIRCH ST
SAN LEANDRO CA
94579-1006
US

V. Phone/Fax

Practice location:
  • Phone: 510-570-6770
  • Fax:
Mailing address:
  • Phone: 510-570-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: