Provider Demographics
NPI:1235211236
Name:LOPEZ, ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
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:PO BOX 11247
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94712-2247
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:
Practice Address - Street 1:2031 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2006
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46784207Q00000X
CAA54812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2274032OtherARAZ
MN782052OtherFAIRVIEW
MN132531OtherUCARE
MN367187900Medicaid
MNHP48293OtherHEALTH PARTNERS
MN935S7LOOtherBCBS
MN01-19261OtherMEDICA-CHOICE
IA0586909Medicaid
MN1042594OtherPREFERRED ONE
MN2274032OtherAMERICA'S PPO
WI34600900Medicaid
MN132531OtherUCARE
MN367187900Medicaid