MEDICARE: DANIEL LOPEZ M.D.

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	A52410	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A524100	OTHER	CA	BLUE SHIELD PROVIDER #
2	330583308	OTHER	CA	BLUE CROSS PROVIDER #

General Provider Information

NPI Number	:	1265430144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LOPEZ M.D.

Provider Business Mailing Address
First Line	:	6475 CAMDEN AVE STE 105
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2847
Country	:	US
Telephone Number	:	408-997-9155
Fax Number	:	408-997-9106

Provider Business Practice Location Address
First Line	:	6475 CAMDEN AVE STE 105
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2847
Country	:	US
Telephone Number	:	408-997-9155
Fax Number	:	408-997-9106

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/12/2024

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