Provider Demographics
NPI:1255537189
Name:JOSEPH F LOPEZ MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JOSEPH F LOPEZ MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-6032
Mailing Address - Street 1:3475 TORRANCE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5800
Mailing Address - Country:US
Mailing Address - Phone:310-540-6032
Mailing Address - Fax:310-543-8743
Practice Address - Street 1:3475 TORRANCE BLVD
Practice Address - Street 2:STE D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5800
Practice Address - Country:US
Practice Address - Phone:310-540-6032
Practice Address - Fax:310-543-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
CAG55217207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G55217AMedicaid
CAW21000Medicare PIN
CAW21000Medicare PIN