Provider Demographics
NPI:1679832422
Name:LOPEZ PAYARES, GISELA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GISELA
Middle Name:MARIA
Last Name:LOPEZ PAYARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GISELA
Other - Middle Name:MARIA
Other - Last Name:LOPEZ PAYARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:161 N CIVIC DR APT 402
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3918
Mailing Address - Country:US
Mailing Address - Phone:281-677-0769
Mailing Address - Fax:
Practice Address - Street 1:2175 N CALIFORNIA BLVD STE 425
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-543-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL141029207L00000X
CAA156370207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program