Provider Demographics
NPI:1790075711
Name:LOPEZ, MARIA ELENA (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 SANTA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3312
Mailing Address - Country:US
Mailing Address - Phone:202-277-1603
Mailing Address - Fax:
Practice Address - Street 1:2615 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3713
Practice Address - Country:US
Practice Address - Phone:202-277-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14273171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist