Provider Demographics
NPI:1184789349
Name:LOPEZ, TONY P (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:P
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MC 8811
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8811
Mailing Address - Country:US
Mailing Address - Phone:619-543-6283
Mailing Address - Fax:619-471-9068
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:MC 8811
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8811
Practice Address - Country:US
Practice Address - Phone:619-543-6283
Practice Address - Fax:619-471-9068
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G4077510Medicaid
CAA48347Medicare UPIN
CAWG40775IMedicare PIN