Provider Demographics
NPI:1265883912
Name:LOPEZ, ANTHONY LUIS (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LUIS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1005 MOANALUA RD
Mailing Address - Street 2:SPC 410
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4702
Mailing Address - Country:US
Mailing Address - Phone:808-488-5555
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty