MEDICARE: ANTOINETTE 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	207Q00000X	Family Medicine Physician	46784	MN
2	207Q00000X	Family Medicine Physician	A54812	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2274032	OTHER	MN	ARAZ
2	782052	OTHER	MN	FAIRVIEW
3	132531	OTHER	MN	UCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	HP48293	OTHER	MN	HEALTH PARTNERS
6	935S7LO	OTHER	MN	BCBS
7	01-19261	OTHER	MN	MEDICA-CHOICE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1042594	OTHER	MN	PREFERRED ONE
10	2274032	OTHER	MN	AMERICA'S PPO
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235211236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE LOPEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 11247
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94712-2247
Country	:	US
Telephone Number	:	510-981-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2031 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2006
Country	:	US
Telephone Number	:	510-981-4100
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/30/2014

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Directions to “ ANTOINETTE LOPEZ MD” Practice Location

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