Provider Demographics
NPI:1487823415
Name:LOPEZ, ELSY NOEMI (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:ELSY
Middle Name:NOEMI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8456 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2244
Mailing Address - Country:US
Mailing Address - Phone:310-916-8709
Mailing Address - Fax:
Practice Address - Street 1:8456 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2244
Practice Address - Country:US
Practice Address - Phone:310-916-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP137124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist