Provider Demographics
NPI:1205034733
Name:LOPEZ, OSCAR A (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
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:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-1846
Mailing Address - Country:US
Mailing Address - Phone:760-351-4400
Mailing Address - Fax:760-351-4407
Practice Address - Street 1:751 W LEGION RD STE 103
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7754
Practice Address - Country:US
Practice Address - Phone:760-351-4400
Practice Address - Fax:760-351-4407
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108837207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205034733Medicare PIN