Provider Demographics
NPI:1932526514
Name:LOPEZ MONCAYO, JAVIER A (MD)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:A
Last Name:LOPEZ MONCAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15216 VANOWEN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3601
Mailing Address - Country:US
Mailing Address - Phone:818-785-7875
Mailing Address - Fax:818-909-7924
Practice Address - Street 1:15216 VANOWEN ST STE 1A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3601
Practice Address - Country:US
Practice Address - Phone:818-785-7875
Practice Address - Fax:818-909-7924
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124126207RG0300X
CAA161893207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine