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General NPI Number Information
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NPI Number | 1023727666
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Entity Type | Individual
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Provider Name | HECTOR MEZA-LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 12902 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2924
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Country | US
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Telephone | 818-284-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 S FIR AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-3724
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Country | US
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Telephone | 310-330-6228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 108184
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License Number State | CA
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