Provider Demographics
NPI:1508885856
Name:LOPEZ, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:2101 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1502
Practice Address - Country:US
Practice Address - Phone:661-758-2263
Practice Address - Fax:661-758-8132
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA80785207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology