MEDICARE: GABRIEL LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1003096439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL LOPEZ

Provider Business Mailing Address
First Line	:	320 W TEMPLE ST
Second Line	:	9TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3208
Country	:	US
Telephone Number	:	213-974-9554
Fax Number	:	213-620-1405

Provider Business Practice Location Address
First Line	:	320 W TEMPLE ST
Second Line	:	9TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3208
Country	:	US
Telephone Number	:	213-974-9554
Fax Number	:	213-620-1405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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Directions to “ GABRIEL LOPEZ ” Practice Location

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