Provider Demographics
NPI:1538469754
Name:GILBERT D LOPES MD
Entity Type:Organization
Organization Name:GILBERT D LOPES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-947-4124
Mailing Address - Street 1:1220 E AVENUE S
Mailing Address - Street 2:SUIITE D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6196
Mailing Address - Country:US
Mailing Address - Phone:661-947-4124
Mailing Address - Fax:661-947-5986
Practice Address - Street 1:1220 E AVENUE S
Practice Address - Street 2:SUIITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6196
Practice Address - Country:US
Practice Address - Phone:661-947-4124
Practice Address - Fax:661-947-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40232261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A402321Medicaid
CAA29084Medicare UPIN
CAA40232Medicare PIN