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General NPI Number Information
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NPI Number | 1164503652
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Entity Type | Organization
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Legal Business Name | LAS PALMAS MEDICAL GROUP
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1003 N. STATE STREET
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City | HEMET
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State | CA
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Zip | 92543-4435
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Country | US
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Telephone | 951-652-0090
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Fax | 951-652-0907
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Provider Business Mailing Address
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Address Line | 1003 N. STATE STREET
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City | HEMET
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State | CA
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Zip | 92543-4435
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Country | US
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Telephone | 951-652-0090
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Fax | 951-652-0907
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. IRMA LOPEZ
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Credential | M.D.
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Telephone | 951-652-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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