MEDICARE: MAURICIO EMANUEL 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	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1841837721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICIO EMANUEL LOPEZ

Provider Business Mailing Address
First Line	:	901 W VICTORIA ST STE F&G
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-5807
Country	:	US
Telephone Number	:	310-669-9510
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W VICTORIA ST STE F&G
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-5807
Country	:	US
Telephone Number	:	310-669-9510
Fax Number	:

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	06/02/2026

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