Provider Demographics
NPI:1578566246
Name:LOPEZ, LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:LOPEZ
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 1:722 MEDICAL CENTER DR E STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6810
Mailing Address - Country:US
Mailing Address - Phone:559-297-9500
Mailing Address - Fax:559-297-9572
Practice Address - Street 1:722 MEDICAL CENTER DR E STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6810
Practice Address - Country:US
Practice Address - Phone:559-297-9500
Practice Address - Fax:559-297-9572
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62591207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A625910Medicaid
CAGR0085541Medicaid
CAGR0085540Medicaid
CAGR0085541Medicaid