Provider Demographics
NPI:1922201854
Name:LOPEZ, EDUARDO A (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:13652 CANTARA ST # 302
Mailing Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5423
Mailing Address - Country:US
Mailing Address - Phone:818-375-2574
Mailing Address - Fax:818-847-7830
Practice Address - Street 1:13652 CANTARA ST # 302
Practice Address - Street 2:SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2574
Practice Address - Fax:818-847-7830
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA109370207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE416AMedicare UPIN