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General NPI Number Information
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NPI Number | 1710098074
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Entity Type | Individual
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Provider Name | DR. JAVIER ENRIQUE LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 2660 W COVELL BLVD STE A
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City | DAVIS
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State | CA
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Zip | 95616-5645
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Country | US
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Telephone | 530-754-7158
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Fax | 530-754-7167
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Provider Business Mailing Address
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Address Line | 26 SAXTON CT
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City | WALNUT CREEK
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State | CA
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Zip | 94597-2603
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A79848
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License Number State | CA
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