Healthcare Provider Details

I. General information

NPI: 1508885856
Provider Name (Legal Business Name): JUAN MANUEL LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 7TH ST
WASCO CA
93280-1502
US

IV. Provider business mailing address

659 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-2263
  • Fax: 661-758-8132
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA80785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: