Healthcare Provider Details

I. General information

NPI: 1528392925
Provider Name (Legal Business Name): MR. JOHN THOMAS LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42145 LYNDIE LN SUITE# 102
TEMECULA CA
92591-3612
US

IV. Provider business mailing address

42145 LYNDIE LN SUITE# 102
TEMECULA CA
92591-3612
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-4906
  • Fax: 951-587-2625
Mailing address:
  • Phone: 951-699-4906
  • Fax: 951-587-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: