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NPI Code Detail

MEDICARE: JOSE LOPEZ PAC

MEDICARE: JOSE LOPEZ PAC
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
1363A00000XPhysician AssistantPA 18745CA

General Provider Information

NPI Number : 1245364785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE LOPEZ PAC
Provider Business Mailing Address
First Line : PO BOX 31309
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-0309
Country : US
Telephone Number : 323-442-5860
Fax Number :
Provider Business Practice Location Address
First Line : 1520 SAN PABLO ST STE 2000
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-5322
Country : US
Telephone Number : 323-442-5860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 09/11/2018

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Directions to “ JOSE LOPEZ PAC” Practice Location

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