Provider Demographics
NPI:1457567810
Name:LOPEZ, DANIEL (NP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2816
Mailing Address - Country:US
Mailing Address - Phone:209-521-9661
Mailing Address - Fax:209-521-9307
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 230
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2816
Practice Address - Country:US
Practice Address - Phone:209-521-9661
Practice Address - Fax:209-521-9307
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14432363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care