MEDICARE: EMMA LOPEZ

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1679398960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA LOPEZ

Provider Business Mailing Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 OCEANGATE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4302
Country	:	US
Telephone Number	:	562-549-3955
Fax Number	:

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

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “ EMMA LOPEZ ” Practice Location

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