Healthcare Provider Details

I. General information

NPI: 1235363193
Provider Name (Legal Business Name): ANA LOPEZ-O'SULLIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA LOPEZ-O'SULLIVAN

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LOMITA BLVD
TORRANCE CA
90505-5108
US

IV. Provider business mailing address

8006 WESTLAWN AVE
LOS ANGELES CA
90045-2751
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-4997
  • Fax:
Mailing address:
  • Phone: 310-923-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA114378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: