Provider Demographics
NPI:1841823556
Name:LOPEZ, ANDREW RAUL PALAFOX
Entity type:Individual
Prefix:MR
First Name:ANDREW RAUL
Middle Name:PALAFOX
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANDREW RAUL
Other - Middle Name:PALAFOX
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14755 FOOTHILL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8050
Mailing Address - Country:US
Mailing Address - Phone:909-371-0205
Mailing Address - Fax:
Practice Address - Street 1:14755 FOOTHILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8050
Practice Address - Country:US
Practice Address - Phone:909-371-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist