Provider Demographics
NPI:1568495307
Name:LOPRESTI, JOHNATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:
Last Name:LOPRESTI
Suffix:
Gender:M
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50953207RE0101X
CAG48153207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE1617OtherGROUP RAILROAD MEDICARE
CA00G481530OtherBLUE SHIELD
CA1356390009OtherGROUP NPI
CA00G481530Medicaid
CA110239196OtherRAILROAD MEDICARE
CA1902846306OtherGROUP NPI
CAGR0100430OtherGROUP MEDICAL
CAGR0016910OtherGROUP MEDICAID PIN
CAW18762OtherGROUP MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CAW11675OtherGROUP MEDICARE PIN
CA00G481530Medicaid