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General NPI Number Information
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NPI Number | 1992972079
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Entity Type | Organization
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Legal Business Name | CECILIA G. LOPEZ, MD,PC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 3020 S GENESEE RD
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City | BURTON
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State | MI
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Zip | 48519-1420
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Country | US
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Telephone | 810-744-3321
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Fax | 810-744-2850
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Provider Business Mailing Address
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Address Line | 3020 S GENESEE RD
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City | BURTON
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State | MI
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Zip | 48519-1420
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Country | US
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Telephone | 810-744-3321
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Fax | 810-744-2850
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | OSIE LUZ
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Credential |
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Telephone | 810-744-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | CL046551
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License Number State | MI
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