MEDICARE: DR. D. A. 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	207ND0900X	Dermatopathology Physician	G10411	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	:	1649273293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. D. A. LOPEZ M.D.

Provider Business Mailing Address
First Line	:	230 PROSPECT PL
Second Line	:	STE 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1987
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1912

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	STE 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1987
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1912

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/09/2007

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