MEDICARE: DR. CHARLES ERNEST LOPEZ MD

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	207L00000X	Anesthesiology Physician	G71995	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184673170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ERNEST LOPEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 39000
Second Line	:	DEPT # 34237
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94139-0001
Country	:	US
Telephone Number	:	925-951-1366
Fax Number	:	925-951-1385

Provider Business Practice Location Address
First Line	:	20998 REDWOOD RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5918
Country	:	US
Telephone Number	:	510-538-2828
Fax Number	:	510-538-2508

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	01/27/2009

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