Provider Demographics
NPI:1033287305
Name:LOPEZ, GRACIELA (MD)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 CAMINO ARROYO
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7348
Mailing Address - Country:US
Mailing Address - Phone:408-854-6570
Mailing Address - Fax:408-852-2265
Practice Address - Street 1:7475 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7348
Practice Address - Country:US
Practice Address - Phone:408-854-6570
Practice Address - Fax:408-852-2265
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine