Provider Demographics
NPI:1013043942
Name:LOPEZ, SHERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 W SHAW AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3226
Mailing Address - Country:US
Mailing Address - Phone:559-224-4977
Mailing Address - Fax:559-224-4980
Practice Address - Street 1:3209 W SHAW AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3226
Practice Address - Country:US
Practice Address - Phone:559-224-4977
Practice Address - Fax:559-224-4980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX73920Medicaid
CAH39008Medicare UPIN
CA00AX73920Medicaid