Healthcare Provider Details

I. General information

NPI: 1952614182
Provider Name (Legal Business Name): DUSTIN MICHAEL LOPES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DRIVE HBS DEPARTMENT, 5TH FLOOR
VALLEJO CA
94549
US

IV. Provider business mailing address

975 SERENO DRIVE HBS DEPARTMENT, 5TH FLOOR
VALLEJO CA
94549
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-2440
  • Fax: 707-651-2522
Mailing address:
  • Phone: 707-651-2440
  • Fax: 707-651-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: