Provider Demographics
NPI:1356637359
Name:LOPEZ, CLAUDIA ELIZABETH (SA-C, MD (IMG))
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:ELIZABETH
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SA-C, MD (IMG)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3027
Mailing Address - Country:US
Mailing Address - Phone:909-392-6501
Mailing Address - Fax:909-469-2136
Practice Address - Street 1:2333 FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3027
Practice Address - Country:US
Practice Address - Phone:909-392-6501
Practice Address - Fax:909-469-2136
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11-156246ZC0007X
CAA144026207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA144026OtherMD LICENSE
CA1356637359Medicaid
CA1356637359Medicaid