Healthcare Provider Details

I. General information

NPI: 1700939097
Provider Name (Legal Business Name): RICHARD RAMOS LOPEZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST 245
TORRANCE CA
90503-4352
US

IV. Provider business mailing address

10140 BRIDLEVALE DR
LOS ANGELES CA
90064-4656
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-5075
  • Fax: 310-371-5351
Mailing address:
  • Phone: 310-837-2448
  • Fax: 310-837-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG77986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: