Provider Demographics
NPI:1013200278
Name:LOPES DE MENEZES, DAVINA ELVINA
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:ELVINA
Last Name:LOPES DE MENEZES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAVINA
Other - Middle Name:ELVINA
Other - Last Name:LOPES DE MENESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1115 BAYSWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4304
Mailing Address - Country:US
Mailing Address - Phone:650-358-8684
Mailing Address - Fax:
Practice Address - Street 1:7210 MURRAY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3339
Practice Address - Country:US
Practice Address - Phone:209-373-2859
Practice Address - Fax:209-373-2873
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics