MEDICARE: DR. MARTHA CHRISTINA 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1821244955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA CHRISTINA LOPEZ

Provider Business Mailing Address
First Line	:	560 S ST LOUIS ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-4390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N BOYLE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-3418
Country	:	US
Telephone Number	:	323-261-4900
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	09/17/2015

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