Provider Demographics
NPI:1932312600
Name:LOPEZ, LILLIAN YVETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:YVETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 MENTOR AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-0069
Mailing Address - Country:US
Mailing Address - Phone:440-352-4880
Mailing Address - Fax:440-352-3629
Practice Address - Street 1:33758 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2243
Practice Address - Country:US
Practice Address - Phone:909-795-9747
Practice Address - Fax:909-797-3922
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA195175OtherMEDICARE