Provider Demographics
NPI:1437235827
Name:J JULIAN LOPEZ INC
Entity Type:Organization
Organization Name:J JULIAN LOPEZ INC
Other - Org Name:CENTER FOR LIVER AND DIGESTIVE DISESEASE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-496-0991
Mailing Address - Street 1:PO BOX 35679
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5679
Mailing Address - Country:US
Mailing Address - Phone:702-496-0991
Mailing Address - Fax:702-877-6741
Practice Address - Street 1:7106 SMOKE RANCH RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8346
Practice Address - Country:US
Practice Address - Phone:702-496-0991
Practice Address - Fax:702-877-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV0397OtherBCBS ID
NV002019037Medicaid
NV100010704OtherRR MEDICARE
NV1437235827Medicare NSC
NVNV0397OtherBCBS ID
NVD87512Medicare UPIN