Provider Demographics
NPI:1265430144
Name:LOPEZ, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 CAMDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2847
Mailing Address - Country:US
Mailing Address - Phone:408-997-9155
Mailing Address - Fax:408-997-9106
Practice Address - Street 1:6475 CAMDEN AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2847
Practice Address - Country:US
Practice Address - Phone:408-997-9155
Practice Address - Fax:408-997-9106
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524100OtherBLUE SHIELD PROVIDER #
CA330583308OtherBLUE CROSS PROVIDER #
CAF17143Medicare UPIN
CA00A524100Medicare ID - Type Unspecified