MEDICARE: HORACIO G LOPEZ, M.D. , 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	261QP2300X	Primary Care Clinic/Center	A48199	CA

General Provider Information

NPI Number	:	1790184141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORACIO G LOPEZ, M.D. , INC

Provider Business Mailing Address
First Line	:	2105 BEVERLY BLVD STE 129
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2262
Country	:	US
Telephone Number	:	213-353-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 BEVERLY BLVD STE 129
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2262
Country	:	US
Telephone Number	:	213-353-3600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HORACIO G LOPEZ
Credential	:	M.D.
Telephone Number	:	213-353-3600

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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