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General NPI Number Information
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NPI Number | 1336482173
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Entity Type | Individual
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Provider Name | CHARLES LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 25602 ALICIA PKWY STE 219
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5309
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Country | US
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Telephone | 866-796-3965
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Fax | 866-796-3965
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Provider Business Mailing Address
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Address Line | 22096 CAMINITO VINO
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1629
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Country | US
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Telephone | 866-796-3965
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Fax | 866-796-3965
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State | CA
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