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NPI Code Detail

MEDICARE: GLENN ANDREW LOPEZ M.D., M.P.H.

MEDICARE: GLENN ANDREW LOPEZ M.D., M.P.H.
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
1207Q00000XFamily Medicine PhysicianG59193CA

General Provider Information

NPI Number : 1184714040
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN ANDREW LOPEZ M.D., M.P.H.
Provider Business Mailing Address
First Line : 833 1/2 N HELIOTROPE DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90029-2521
Country : US
Telephone Number : 818-314-1738
Fax Number :
Provider Business Practice Location Address
First Line : 808 W 58TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-3632
Country : US
Telephone Number : 323-541-1600
Fax Number : 818-957-4100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 03/28/2017

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