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General NPI Number Information
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NPI Number | 1467663963
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Entity Type | Individual
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Provider Name | MARCO ANTONIO LOPEZ VIZCARRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 26991 CROWN VALLEY PKWY STE 100
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6511
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Country | US
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Telephone | 949-582-5430
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone |
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 45748
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | C134501
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License Number State | CA
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