Physician Compare National (NPI:1578853545)

HEALTHCARE PROVIDER: DANA CARSON LOPEZ PSY.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578853545
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719135961
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120913000613
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LOPEZ
	Individual professional last name
Provider First Name	DANA
	Individual professional first name
Provider Middle Name	L CARSON
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	11440 W BERNARDO CT
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 256
	Group Practice or individual's line 2 address
City	SAN DIEGO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	921271653
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y