MEDICARE: D.A. LOPEZ, MD, INC.

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	174400000X	Specialist	G10411	CA

General Provider Information

NPI Number	:	1679667653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.A. LOPEZ, MD, INC.

Provider Business Mailing Address
First Line	:	230 PROSPECT PL
Second Line	:	SUITE 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1912

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	SUITE 260
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-437-1146
Fax Number	:	619-437-1912

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. D. A. LOPEZ
Credential	:	M.D.
Telephone Number	:	619-437-1146

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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