Provider Demographics
NPI:1629210075
Name:LOPEZ, NOE MANUEL JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NOE
Middle Name:MANUEL
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1695 N SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3701
Mailing Address - Country:US
Mailing Address - Phone:760-323-2118
Mailing Address - Fax:760-416-1651
Practice Address - Street 1:510 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2904
Practice Address - Country:US
Practice Address - Phone:213-483-3600
Practice Address - Fax:213-483-4555
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2018-06-28
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Provider Licenses
StateLicense IDTaxonomies
CAPA20105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical