Provider Demographics
NPI:1720844889
Name:LOPEZ, ALEJANDRO DAVID
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:DAVID
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 WATTERS DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2256
Mailing Address - Country:US
Mailing Address - Phone:510-295-3730
Mailing Address - Fax:
Practice Address - Street 1:18411 WATTERS DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2256
Practice Address - Country:US
Practice Address - Phone:510-295-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program