Provider Demographics
NPI:1912219916
Name:LOPEZ, DELMY
Entity Type:Individual
Prefix:MS
First Name:DELMY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14934 LOFTHILL DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5138
Mailing Address - Country:US
Mailing Address - Phone:714-609-1205
Mailing Address - Fax:
Practice Address - Street 1:1406 N AZUSA AVE STE C
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1257
Practice Address - Country:US
Practice Address - Phone:626-858-9940
Practice Address - Fax:626-858-9366
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55025126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant