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General NPI Number Information
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NPI Number | 1013276807
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Entity Type | Organization
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Legal Business Name | JORGE LOPEZ MD INC.
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 49430 ROAD 426 SUITE B
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City | OAKHURST
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State | CA
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Zip | 93644-8618
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Country | US
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Telephone | 559-683-2459
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Fax | 559-683-6885
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Provider Business Mailing Address
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Address Line | PO BOX 2588
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City | OAKHURST
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State | CA
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Zip | 93644-2588
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Country | US
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Telephone | 559-683-2459
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Fax | 559-683-6885
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE LUIS LOPEZ-AGUADO
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Credential | M.D.
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Telephone | 559-683-2459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G63333
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License Number State | CA
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