Provider Demographics
NPI:1013276807
Name:JORGE LOPEZ MD INC.
Entity Type:Organization
Organization Name:JORGE LOPEZ MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ-AGUADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-683-2459
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-2588
Mailing Address - Country:US
Mailing Address - Phone:559-683-2459
Mailing Address - Fax:559-683-6885
Practice Address - Street 1:49430 ROAD 426
Practice Address - Street 2:SUITE B
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8618
Practice Address - Country:US
Practice Address - Phone:559-683-2459
Practice Address - Fax:559-683-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty