Provider Demographics
NPI:1841558434
Name:LOPEZ, JOSE VELASCO JR
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VELASCO
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:VELASCO
Other - Last Name:LOPEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2811 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2908
Mailing Address - Country:US
Mailing Address - Phone:323-543-1900
Mailing Address - Fax:
Practice Address - Street 1:2811 MARSH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2908
Practice Address - Country:US
Practice Address - Phone:323-543-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice