Provider Demographics
NPI:1013051879
Name:LOPATOSKY, CHRIS (PA)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:LOPATOSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PALM AVE
Mailing Address - Street 2:SUITE 340 B
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1229
Mailing Address - Country:US
Mailing Address - Phone:619-429-7700
Mailing Address - Fax:619-429-7703
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:SUITE 340 B
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1978
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:619-435-0151
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10623363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR40144Medicare UPIN