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1760174015 NPI number — DEMITRI E LOPEZ

NPI Number: 1760174015
Health Care Provider/Practitioner: DEMITRI E LOPEZ

Information about “1760174015” NPI (DEMITRI E LOPEZ) exists in 1760174015 in HTML format HTML  |  1760174015 in plain Text format TXT  |  1760174015 in PDF (Portable Document Format) PDF  |  1760174015 in an XML format XML  formats.

NPI Number : 1760174015 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760174015",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOPEZ",
    "FirstName": "DEMITRI",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "520 S EUCLID ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA HABRA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90631-6111",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "562-337-2771",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2750 E WASHINGTON BLVD STE 230",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PASADENA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91107-1449",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-296-8900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/24/2023",
    "LastUpdateDate": "05/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "373H00000X",
          "TaxonomyName": "Day Training/Habilitation Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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